[Early papillary muscle rupture in myocardial infarction, diagnosis with transesophageal echography]. / Rottura precoce di muscolo papillare in corso di infarto miocardico, diagnosi con ecografia transesofagea.

We describe the case of posterior papillary muscle (PPM) rupture with severe mitral regurgitation at the very beginning of an inferior myocardial infarction (MI) in a 79-year-old woman. The diagnosis was made by transesophageal echocardiography (TEE) and confirmed at autopsy. This case confirms the value of TEE in diagnosing PPM rupture and the association of PPM rupture with small posterior myocardial infarction. Moreover the case presents some unusual aspects: the rupture occurred very early; at transthoracic approach, a systolic convergence flow zone was the only sign of mitral regurgitation by color flow mapping; at TEE flail mitral leaflets were absent; in systole, the trunked papillary muscle did not prolapse into the left atrial cavity, but crushed into the atrial side of posterior mitral leaflet, remaining at the atrioventricular level; at autopsy, there was a split PPM with a completely ruptured medial branch. On the atrial side of the posterior mitral leaflet there was an ecchimothic zone, due to the crushing of the PPM.

Morphometric study of primary cutaneous germinal center cell lymphomas.

BACKGROUND: Primary cutaneous germinal center cell lymphomas (PCGCCL) are B-cell neoplasias; most are mixed cell type, composed of small and large cleaved cells and large noncleaved cells (centrocytes and centroblasts). Because of the significant pleomorphism of the cells, which ranged in size from small elements with indented nuclei to larger ones with multilobulated vesiculous nuclei, histopathologic examination of PCGCCL of mixed cell type has the worst degree of histologic interobserver reproducibility. METHODS: In this study, the authors determined whether the light microscopic morphologic classification criteria applied in quantifying cleaved and noncleaved cells in these lymphomas are substantiated by morphometric analysis and have good reproducibility in differentiating the various cell subsets. They used an image analyzer (IBAS 2000, Zeiss Kontron, Munich, Germany) to study 17 centroblastic/centrocytic and centroblastic follicular and/or diffuse primary cutaneous lymphomas. RESULTS: The data obtained showed morphometric differences between the follicular and diffuse patterns of neoplastic cells. In follicular neoplasms, the cells tend to be smaller, more cleaved, and more monomorphic than those observed in the diffuse forms. In all the follicular and diffuse cases, the authors observed a unimodal population with a wide peak composed of cells with intermediate morphometric features that cannot be labeled properly. CONCLUSIONS: These data underline the considerable overlap of nuclear parameters of lymphocytes between the subtypes of cells in cutaneous mixed small and large cell lymphoma, making the Kiel classification and Working Formulation unsuitable for this kind of neoplasia and supporting revision of classification criteria in cutaneous germinal center cell lymphomas.

[Human dirofilariasis: discovery of a gravid female of Dirofilaria repens in a subcutaneous nodule]. / Dirofilariasi umana: ritrovamento di femmina gravida di Dirofilaria repens in nodulo sottocutaneo.

A case of human subcutaneous dirofilariasis occurred in a 53 years old woman from Scafati (Salerno province). It was localized in the left submammary region. The patient was operated 16 years ago for a papillary carcinoma of the thyroid. For this reason a metastasis was clinically suspected. The histological examination revealed the presence of a granulomatous nodule formed around a Dirofilaria repens gravid female in the subcutaneous tissue. The presence of microfilariae in the uterus of the nematode would suggest that also a mature male was present at the same time in the patient, although it was not possible to localise it. Haematic eosinophilia was observed.