Epignathus with oropharynx destruction.

Epignathus, is a rare oropharyngeal teratoma arising from the head and neck region. Sporadic cases have been described with associated intracerebral teratoma. Even more infrequent and extraordinary is the circumstance of a teratoma with oropharynx destruction. We describe the case of a fetus with pharyngeal mass that completely destroyed the oral cavity. The histological examination revealed an immature teratoma (G3); only one other G3 case has been described.

Epignathus with oropharynx destruction

Epignathus, is a rare oropharyngeal teratoma arising from the head and neck region. Sporadic cases have been described with associated intracerebral teratoma. Even more infrequent and extraordinary is the circumstance of a teratoma with oropharynx destruction. We describe the case of a fetus with pharyngeal mass that completely destroyed the oral cavity. The histological examination revealed an immature teratoma (G3); only one other G3 case has been described.

Sudden onset acute liver failure in a patient with clinically occult small cell lung carcinoma: autopsy report and review of the medical literature.

Liver metastases are commonly found in advanced cancer patients; however, acute liver failure secondary to diffuse liver infiltration is rare. Small cell lung carcinoma accounts for 15% of lung carcinomas. We describe the ninth case of small cell lung carcinoma massively metastatic to the liver, reported in the scientific literature, with sudden clinical onset and death after a few days. An autopsy was performed to understand the cause of death.

Sudden onset acute liver failure in a patient with clinically occult small cell lung carcinoma: autopsy report and review of the medical literature

Liver metastases are commonly found in advanced cancer patients; however, acute liver failure secondary to diffuse liver infiltration is rare. Small cell lung carcinoma accounts for 15% of lung carcinomas. We describe the ninth case of small cell lung carcinoma massively metastatic to the liver, reported in the scientific literature, with sudden clinical onset and death after a few days. An autopsy was performed to understand the cause of death.

Huge Candida albicans normal native tricuspid valve endocarditis

Fungal endocarditis has become an important infection associated with medical progress and the modern lifestyle. In particular, Candida spp. is a rare but important cause of infective endocarditis. We report the case of a 28-year-old woman­quadriplegic and bedridden from birth­who died after repeated episodes of pneumonia treated with different regimens of intravenous antibiotics. A medico legal autopsy was performed, which diagnosed severe Candida native valve infective endocarditis (CIE). This case report illustrates the prolonged use of antibiotic treatment as a possible risk factor for the development of CIE. We also considered how the bedridden condition and the presence of a central venous catheter may be additional risk factors for the development of this entity. Finally, we examined the absence of peripheral embolization in the setting of endocarditis of the right side of the heart.

Huge Candida albicans normal native tricuspid valve endocarditis.

Fungal endocarditis has become an important infection associated with medical progress and the modern lifestyle. In particular, Candida spp. is a rare but important cause of infective endocarditis. We report the case of a 28-year-old woman-quadriplegic and bedridden from birth-who died after repeated episodes of pneumonia treated with different regimens of intravenous antibiotics. A medico legal autopsy was performed, which diagnosed severe Candida native valve infective endocarditis (CIE). This case report illustrates the prolonged use of antibiotic treatment as a possible risk factor for the development of CIE. We also considered how the bedridden condition and the presence of a central venous catheter may be additional risk factors for the development of this entity. Finally, we examined the absence of peripheral embolization in the setting of endocarditis of the right side of the heart.

Periprostatic Perineurioma, Description of a Case With Unusual Localization.

Perineurioma is a rare entity, it is a benign peripheral nerve sheath tumor entirely composed of perineurial cells. A 62-year-old male patient was admitted to our hospital, suffering from scrotal and pelvic pain combined with a severe and continuous pain in his right thigh. A transrectal ultrasound revealed a periprostatic oval lesion of about 5 cm in maximum diameter. A sovrapubic laparotomy was performed with a complete tumor excision. The morphological and immunohistochemical data were most consistent with the diagnosis of perineurioma.

Effect of PDGF, IGF-1 and PRP on the implant osseointegration. An histological and immunohistochemical study in rabbits.

The ability of platelet-derived growth factor (PDGF), insulin-like growth factor-1 (IGF-1) and platelet-rich plasma (PRP) to increase the rate of osseointegration of endosseous implants and to improve the quality of bone remodeling on the surface of titanium, has been investigated in an experimental intraosseous defect model by an histological and immunohistochemical evaluation. The results from this study demonstrate that rabbits treated with the combination PDGF/IGF-1 showed a higher positive effect on bone regeneration than PRP-treated or controls.

Detection of 14 human papillomavirus genotypes in cervical samples in women from a central-southern area of Italy showing different Pap test results.

We evaluated the prevalence of human papillomavirus (HPV) infection and correlated the molecular test results with the cytological examination data (PAP test) in 364 women living in central-southern Italy (Molise region), by means of polymerase chain reaction HPV DNA genotyping and of cervical cytology. One hundred and twenty-eight women resulted HPV positive (35.2%), HPV16 being the most frequent genotype. HPV positive women were significantly younger than negative patients (35.9 +/- 8.4 years and 38.2 +/- 9.1, respectively; p = 0.018); women with multiple infections were also significantly younger than those with single infection (31.7 +/- 6.9 and 37.6 +/- 8.3, respectively; p = 0.0002). Moreover, high risk HPV positive patients were significantly younger than low risk HPV positive women (35.1 +/- 7.7 and 40.5 +/- 10.5, respectively; p = 0.008). In the HPV positive group, 14 patients (10.9%) did not show any significant cytological alteration. Conversely, 7 out of 236 HPV negative women (3.0%) showed high grade squamous intraepithelial lesions (HSIL). Furthermore, HPV 16 or 18 were present in more than 70% of women positive for HSIL at cytology. Our data suggest the potential effectiveness of combined cytology and molecular test for further study of clinical cases with apparently laboratory conflicting results.

Is frozen section analysis of pelvic lymph nodes accurate in locally advanced cervical cancer patients administered preoperative chemoradiation?

OBJECTIVE: No thorough investigation of the diagnostic performance of frozen section analysis in predicting the final status of lymph nodes after exposure to concomitant chemoradiation (CT/RT) has been performed until now. The aim of the study was to analyze the accuracy of pelvic lymph node frozen section examination in a large, consecutive series of locally advanced cervical cancer (LACC) patients undergoing preoperative CT/RT. METHODS: A total of 123 consecutive LACC patients underwent preoperative CT/RT followed by radical hysterectomy according to Piver classification, with bilateral systematic pelvic lymphadenectomy. If pelvic nodes were intraoperatively defined as positive for tumor metastasis, para-aortic lymphadenectomy up to inferior mesenteric artery was carried out. The diagnostic performance of frozen section examination of pelvic lymph nodes was assessed by calculating the negative predictive value (NPV), the positive predictive value (PPV), specificity, sensitivity, and overall accuracy. RESULTS: A total of 1647 and 4345 pelvic lymph nodes were analyzed by frozen section examination and at final diagnosis, respectively. Lymph node metastases were found in 11 cases (8.9%) at frozen section examination, and in 14 cases (11.4%) at definitive histological diagnosis. We found 7 incorrect diagnoses at frozen section examination, represented by 5 false negative and 2 false positive cases. Specificity, sensitivity, overall accuracy, NPV, and PPV were 98.2%, 64.3%, 94.3%, 95.5% and 81.8%, respectively. CONCLUSIONS: Preoperative chemoradiation does not impair the role of frozen section analysis in predicting the pelvic lymph node involvement in LACC patients.

Ovarian endomyometrioma with atypias: description of a case.

OBJECTIVE: To report on a patient with endomyometrioma with atypias and to review the literature. DESIGN: Case report and literature review. SETTING: Clinical and pathologic. PATIENT(S): A 33-year-old nulliparous woman with right flank pain and infertility. MAIN OUTCOME MEASURE(S): Accuracy of diagnosis, hypotheses on endomyometrioma pathogenesis. RESULT(S): A 33-year-old woman with an 8-cm right ovarian mass is reported. An extensive review of the literature on this rare disease revealed only nine well-documented cases with different views on pathogenesis. The final diagnosis required an accurate sampling and the aid of immunohistochemical markers. CONCLUSION(S): Endomyometrioma is an extremely rare entity. None of the previous cases showed cytologic atypias. The finding of atypias, in analogy with endometriosis, suggests the müllerian metaplastic theory.

Endometrial cancer arising in both horns of didelphys uterus in a Down's syndrome woman.

BACKGROUND: There are only few reports of endometrial cancer arising in patients with uterine malformations. Down's syndrome is characterized by a reduced risk of solid tumors, and there are no reports about its correlation with uterine malformations. CASE: An endometrial adenocarcinoma arising in both horns of a didelphys uterus of a Down's syndrome woman. CONCLUSION: Uterine malformations and genetical disorders may cause a delayed diagnosis of gynecological cancers. Gynecological examination in asymptomatic patients and differential diagnosis in abnormal uterine bleeding patients should be considered.