Integration of reflectance confocal microscopy in sequential dermoscopy follow-up improves melanoma detection accuracy.

BACKGROUND: Successful treatment of melanoma depends on early diagnosis, but its varied clinical presentation means that no single noninvasive method or criterion can provide reliable detection in all cases. OBJECTIVES: To determine whether combining sequential dermoscopy imaging with reflectance confocal microscopy (RCM) can improve melanoma detection and reduce the burden of unnecessary excisions. METHODS: We conducted a retrospective study with median follow-up of 25 months. We included equivocal pigmented lesions that lacked clear dermoscopy criteria for melanoma at baseline but were excised subsequently because of changes during digital monitoring. RCM imaging was performed before excision. Main melanoma dermoscopy features, seven-point checklist score at baseline, and changes in structure and/or colour, and development of new melanoma-specific criteria at follow-up (scored as major, moderate or minor) were considered. Main melanoma RCM criteria were evaluated and diagnosis was made. Histopathological diagnosis was the reference standard for defining parameter frequency and diagnostic accuracy. RESULTS: Seventy lesions were included. Major changes were more frequently correlated with melanoma diagnosis, although one-third (four of 12) of melanomas showed moderate or minor changes. Cytological atypia and architectural disarrangement on RCM were correlated with melanoma diagnosis. A correct melanoma diagnosis was achieved with RCM in almost all cases (11 of 12, 92%). Referring for excision only those lesions with RCM-positive features and/or presenting major changes at digital dermoscopy follow-up, theoretically 27 of 58 naevi could be saved from surgery. CONCLUSIONS: Integration of RCM in the clinical and instrumental strategy for managing difficult pigmented lesions provided additional diagnostic information useful in the decision-making process.

Locally advanced ovarian carcinoid.

Primary carcinoid tumor of the ovary is an extremely rare neoplasm, accounting for less than 0.1 % of all ovarian neoplasms. We report a case of a 79-year-old woman with locally advanced ovarian carcinoid presenting as acute abdomen. At laparotomy, a large mass appeared in the pelvis, with maximum size of 18 cm, growing from the left ovary with infiltration of the left Fallopian tube and compression of the small bowel and the sigmoid tract. A bilateral salpingo-oophorectomy was performed, and the tumor mass was completely removed. Post-operative treatments were not considered due to the absence of data in literature to support adjuvant treatments. Ten years after surgery the patient remains well without evidence of recurrence. Older age should not be considered an absolute contraindication for aggressive surgery, if this represents the best chance of cure. An aggressive cytoreductive surgery remains the best treatment for advanced or locally advanced primary ovarian carcinoid.

Tyrosine kinase inhibitor imatinib mesylate as anticancer agent for advanced ocular melanoma expressing immunoistochemical C-KIT (CD 117): preliminary results of a compassionate use clinical trial.

Imatinib mesylate (IM), is a selective and competitive inhibitor of tyrosine kinases, including BCR-ABL, ABL, KIT, and the platelet-derived growth factor receptors (PDGF-R). It binds to the ATP-binding site of the target kinase and prevents the transfer of phosphate from ATP to the tyrosine residues of various substrates. At oral doses of 200-600 mg, the majority of patients with chronic myeloid leukaemia, Philadelphia chromosome-positive acute lymphoblastic leukemia expressing the BCR-ABL fusion protein and gastrointestinal stromal tumours (GIST) achieve a bio-molecular and clinical response, frequently complete, associated with limited toxicity. Several other human cancers, as small-cell lung carcinoma, melanoma, seminoma, some sarcomas, and adenoid cystic carcinomas may over-express KIT or PDGF-R, and clinical trials to evaluate the role of IM in the treatment of such cancers are currently ongoing. We determined c-KIT with Dako CD 117 antibody in 5 cases of advanced ocular melanoma (OM) and we found positive immuno-reactivity for CD 117 in three patients. We treated all patients with palliative-use IM at the oral dose of 400 mgr daily. We obtained in expressing positive immuno-reactivity for CD 117 patients: a reduction of malignant ascites in one, a partial remission in the neck nodes in another, and progression of liver metastases in the third. Evidences of progression has been reported in the other two patients expressing negative immuno-reactivity for CD 117. We conclude that the effect of IM should be assessed only in OM with positive immuno-histochemical c-kit (CD 117) expression. IM might be a potential therapeutic strategy for these patients.

Is it possible to define a better ASCUS class in cervicovaginal screening? A review of 187 cases.

OBJECTIVE: To try to better define the cytologic diagnosis of atypical squamous cells of undetermined significance (ASCUS) in a cervical screening protocol. STUDY DESIGN: Smears from 187 patients with cytologic diagnoses of ASCUS and histologic or two years' cytologic/colposcopic follow-up were reviewed. When an ASCUS diagnosis was confirmed, it was done strictly on the basis of the morphologic criteria recommended by the Regione Emilia Romagna Screening Protocol in 1997, trying also to subclassify ASCUS into favor reactive or favor neoplasia. RESULTS: Seventy ASCUS cases were negative (37.4%). Three cases (1.6%) were low grade squamous intraepithelial lesion, and seven (3.8%) were high grade squamous intraepithelial lesion. One hundred seven ASCUS cases (57.2%) were confirmed. Among the 70 negative cases, 36 (51.4%) had reactive changes on biopsy, 30 (42.9%) koilocytosis, 3 cervical intraepithelial neoplasia (CIN 1) and one CIN not otherwise specified (5.7% total). CONCLUSION: Reclassification of ASCUS cases using tighter criteria reduced them to a rate of 57.2% but missed 30 patients with histologic diagnoses of koilocytosis and 4 with histologic diagnoses of CIN.

Prognostic and predictive value of intratumoral microvessels density in operable non-small-cell lung cancer.

Experimental evidence suggests that tumor growth and progression depend on angiogenesis. In a retrospective study we evaluated the relationship between tumor angiogenesis and survival in patients with NSCLC treated with potentially curative surgery between 1992 and 1997. The study population consisted of 76 patients. An anti-CD34 monoclonal antibody was used to measure angiogenesis in tumor samples. Angiogenesis was quantified in terms of microvessel count (MVC): in each sample the three most intense regions of neovascularization were identified under low microscopic power. A x250 field in each of the three areas was then counted and the highest count of the three fields was recorded. Disease free (DFS) and overall survival (OS) during follow up were evaluated. Gender, age, stage, histologic type and KI-67 were the other factors considered for analysis. The median MVC in our series was 41.5. Among the clinicopathologic parameters examined the microvessel count was the only one to show a significant association with disease free survival in univariate analysis (P = 0.04). MVC value is a new indicator of tumor aggressiveness in patients with NSCLC who underwent potentially curative surgery and should be taken into consideration in selecting patients for adjuvant treatment.

Distal hyperplastic polyps do not predict proximal adenomas: results from a multicentric study of colorectal adenomas.

BACKGROUND: The association between distal hyperplastic polyps and proximal adenomas is still a matter of debate. We investigated this association while taking into account patient characteristics. METHODS: After exclusion of patients with inflammatory bowel diseases, familial adenomatous polyposis, or any cancer, 3088 eligible consecutive subjects aged 18 to 69 years underwent total colonoscopy in four gastroenterology units. The odds ratios (OR) of having proximal adenomas according to patient characteristics (age, sex, medical center, year of endoscopy, reasons for referral, and distal findings) were estimated in univariate and multivariate analyses. RESULTS: Patients with distal polyps of any type showed an adjusted OR of 2.5 (95% CI [1.9, 3.1] p < .001) of having proximal adenomas as compared with those without distal polyps. When distal adenomas and distal hyperplastic polyps were included in the multivariate model as independent factors, the presence of adenomas significantly increased the risk of proximal adenomas (OR = 2.8: 95% CI [2.2, 3.6] p < .001), whereas the presence of hyperplastic polyps did not (OR = 1.1: 95% CI [0.8, 1.5] p = .64). No association with number, size, or location of distal hyperplastic polyps was seen. CONCLUSIONS: Our data show that the presence of hyperplastic polyps should not be the sole indication for total colonoscopy because they are not associated with proximal adenomas when adjusting for patient characteristics and presence of distal adenomas.

Correlation between the histopathology and the epiluminescence microscopy features of malignant blue nevus.

BACKGROUND: The validation of epiluminescence microscopy (ELM) for the diagnosis of pigmented skin lesions is conditional on the demonstration of consistent histologic correlates of the ELM patterns. The ELM characteristics of malignant blue nevus (MBN) have never been reported previously. OBJECTIVE: To evaluate the histologic counterparts of the ELM features of a case of MBN. METHODS: Comparison between the histologic characteristics observed in step-sections of the lesion and the structures observed in a digital ELM image. RESULTS: On ELM, the lesion showed a diffuse whitish-blue veil, round black blotches, a collection of dark colored punctate spots, and fragmented bluish reticular-like formations in the periphery. At histologic examination, the black blotches and the spots appeared to correlate with areas of intense focal necrosis in the papillary and reticular dermis, and the reticular-like structures were demonstrated to correspond to the presence of free melanin and melanophages in the papillary dermis. CONCLUSION: In this case of MBN, blotches and spots seen on ELM correlated with intense necrosis in the papillary and reticular dermis, and reticular-like formations were the counterparts of free melanin and melanophages in the papillary dermis.

Hyalinizing trabecular adenoma of the thyroid. Report of two cases, with cytologic, immunohistochemical and ultrastructural studies.

The cytologic, histologic, immunocytochemical and ultrastructural features of 2 cases of hyalinizing trabecular adenoma (HTA) of the thyroid are described. The difficulty of a cytologic diagnosis and the need for an immunohistochemical profile of the lesions for a final histologic diagnosis are emphasized.

Breslow thickness of cutaneous malignant melanoma in Ravenna (northern Italy) 1981-1990.

The distribution of Breslow's thickness by sex, age and site of 95 of the 103 cases of primary cutaneous malignant melanoma (CMM) diagnosed in 1981-1990 in the Ravenna Health District (a low-incidence area in northern Italy) was studied. The median patient age was 57 years. The median tumor thickness was 1.33 mm in females and 2.15 mm in males (two-tailed Wilcoxon rank sum test, p = 0.153). Significantly thinner lesions were found among women up to the median age than among men of the same age group (1.05 mm vs. 1.80 mm, p = 0.034) and older women (2.20 mm, p = 0.035). The difference between males aged under 57 years and older than 57 was not significant (1.80 mm vs. 2.20 mm, p = 0.828). As a consequence, younger women compared favorably with the rest of the population as a whole (2.20 mm, p = 0.011). No significant differences in site-specific median tumor thickness were found between the sexes or between young and older males, whereas CMMs of the legs among females were thinner in the younger age group (0.67 mm vs. 2.20 mm, p = 0.007). The prevalence of younger women in the recognition of early CMM was entirely accounted for by a substantial shift observed in the most recent 5-year period (from 2.40 mm to 0.70 mm, p = 0.006). Specific educational activities have never been carried out in Ravenna.

Atypical carcinoid of the larynx: case report.

The authors describe a rare case of laryngeal atypical carcinoid. They discuss the histologic pattern of the neoplasm and the differential diagnosis of laryngeal tumors, particularly with oat-cell carcinoma. These tumors represent a spectrum of neoplasms with endocrine differentiation.

Metastasizing meningeal melanocytoma.

The first case in the literature of a metastasizing meningeal melanocytoma is described. The tumor, which arose at the D9-D11 spinal cord level of a 46-year-old woman, metastasized 7 years later to the latero-suprasellar region.