Segmental infarction of the testis: can frozen sections avoid orchidectomy?

Segmental infarction (SI) of the testis is a rare condition that can masquerade as a mass lesion, thus requiring exclusion of tumour. If clinical exams do not exclude a neoplastic lesion with certainty, orchidectomy is usually performed. A case of SI of the testis is presented; the use of frozen section of the enucleated mass demonstrated the ischaemic nature of the lesion, so avoiding orchidectomy. The 8 year follow-up was uneventful. The use of frozen section in SI could permit the selection of cases in which testicular-sparing surgery should be considered.

[Parosteal ossifying lipoma of the femur. Description of a case]. / Lipoma parosteo ossificante del femore. Descrizione di un caso.

A case of parosteal ossifyng lipoma of femour in 67 years-old female patient is described. Review of literature (1966-1999) about parosteal lipoma reveals less then 70 referred cases; much less common is the ossifyng type; in our knowledge five cases of this very rare subtype are referred in last thirty years.

[Vesicouterine fistula and bladder endometriosis. A case report]. / Fistola vescicouterina ed endometriosi vesicale.

Vesicouterine fistula is rare, accounting nearly 4% of all urogenital fistulas. Cesarean delivery through uterine lower segment is the main predisposing event but in the last years other possible predisposing factors have been pointed out. Clinically, it can occur in different forms and the diagnosis is often delayed although it is not difficult. In this study personal experience in a case of postcesarean vesicouterine fistula arisen on a focus of bladder endometriosis is reported and an eventual hypothetical pathogenetic correlation between bladder endometriosis and vesicouterine fistula is discussed.

Thymidylate synthase protein expression in primary colorectal cancer compared with the corresponding distant metastases and relationship with the clinical response to 5-fluorouracil.

Thymidylate synthase (TS) expression in colorectal cancer metastases has been shown to predict for the clinical response to 5-fluorouracil. Because primary tumors may easily provide accessible sources of tissue for marker analysis, we have investigated the stability of TS expression between primary colorectal cancer and the corresponding distant metastases and compared their relative ability to predict response to chemotherapy on a series of 27 patients homogeneously treated with biochemically modulated fluorouracil for advanced disease. By immunohistochemistry, high levels of TS expression were observed in 19 of 27 (70%) primary tumors and in 13 of 27 (48%) metastatic samples. Overall, TS levels observed in primary tumors did not correlate with those measured in the corresponding metastases (r = 0.30, P = 0.13), with higher TS levels in primary tumors in 8 of 10 discordant cases. Accordingly, the degree of TS immunoreactivity was significantly higher in primary tumors compared with the corresponding metastases (mean TS score 3.8; median, 4 versus 2.8; median 3; P = 0.001). Response rates after chemotherapy for metastatic disease were similar for patients with low and high TS levels in their primary tumors (37% versus 53%, P = 0.47). In contrast, response rates were 71% and 23% in patients with low and high TS in metastatic samples (P = 0.012), respectively. In summary, TS levels measured in primary colorectal cancer do not reflect those observed in the corresponding metastases and cannot be used to predict their response to chemotherapy. The basis for the higher TS content of primary colorectal cancer compared with the corresponding metastases needs clarification.

Immunohistochemical quantitation of thymidylate synthase expression in colorectal cancer metastases predicts for clinical outcome to fluorouracil-based chemotherapy.

PURPOSE: To determine whether immunohistochemical thymidylate synthase (TS) quantitation predicts for clinical outcome in patients with advanced colorectal cancer treated by fluorouracil (FUra)-based chemotherapy. PATIENTS AND METHODS: TS levels were measured immunohistochemically on archival specimens of colorectal cancer metastases from 48 patients homogenously treated by bolus FUra plus methotrexate alternating with continuous-infusion FUra plus leucovorin. These measurements were retrospectively correlated with patient characteristics and clinical outcome. RESULTS: A significant correlation was found between intratumoral TS expression and all the parameters of clinical outcome analyzed. In patients whose tumors had low (n = 27) and high (n = 21) TS levels, the overall response rates were 67% and 24%, respectively (P =.003). The percentage of tumor shrinkage after chemotherapy was linearly related to TS immunoreactivity (r =.56, P =.00004), and its mean values were 65% and 14% with low and high TS levels, respectively (P =.0001). By logistic regression analysis, low TS expression was the single best predictor of response to chemotherapy (relative probability, 5.0). In patients with low and high TS expression, the median time to progression was 9.6 months v 6.2 months (P =.005) and the median survival time 18.4 months v 15.4 months (P =.02), respectively. Two- and 3-year survival rates were 41% v 15% and 19% v 0% (P =.02), respectively. CONCLUSION: In this cohort of homogenously treated patients, intratumor TS content was a major predictor of clinical outcome. Immunohistochemical TS quantitation provides a convenient, low-cost technique for identifying patients unresponsive to TS inhibitors who may be candidates for alternative chemotherapy regimens.

Thymidylate synthase protein expression in advanced colon cancer: correlation with the site of metastasis and the clinical response to leucovorin-modulated bolus 5-fluorouracil.

Recently, we have demonstrated that thymidylate synthase (TS) protein expression predicts for the clinical response to a regimen of infusional 5-fluorouracil (5FU) in advanced colorectal cancer patients. Previous studies by other groups that showed a correlation between TS gene expression and response to the fluoropyrimidine also involved infusional regimens. Considering the putatively different mechanism of action of bolus compared with continuous infusion of 5FU, the aim of the present study was to test whether the correlation between TS expression and the clinical response to 5FU is valid for bolus regimens. A secondary aim was to compare TS levels between liver metastases and abdominal recurrences from colon cancer, because these sites have a distinctly different responsiveness to 5FU chemotherapy. The study population consisted of 41 patients (25 males and 16 females; median age, 60 years) with unresectable metastatic or recurrent colon cancer, homogeneously treated with 5FU (420 mg/m2 i.v., days 1-5) and leucovorin (20 mg/m2 i.v., days 1-5); cycles were repeated every 28 days. Twenty-seven patients (66%) showed high levels of TS expression as defined by TS scores equal to 3 and 4. The proportion of cases with high levels of TS expression was significantly higher in abdominal recurrences (18 of 22, 82%) compared with liver metastases (9 of 19, 47%; P = 0.02). Intratumoral TS protein expression was inversely correlated with response to chemotherapy (response rate: 7 of 14, 50%, versus 0 of 27 in patients with low and high levels of TS expression, respectively; P = 0.0001). These results confirm that the level of TS protein expression predicts for response to 5FU, even with a bolus schedule. The higher TS levels observed in abdominal compared with liver metastases may account for their different responsiveness to 5FU chemotherapy. Immunohistochemical quantitation of TS protein levels may thus allow us to change the therapeutic approach to advanced colorectal cancer from a general to an individual treatment strategy at a time when new non TS-targeted drugs have become available for this disease.

Lymphocytic hypophysitis. Case report.

Lymphocytic hypophysitis is a very unusual disease typically observed in the peripartum period but found also in non-pregnant women or in men. We report the case of a 50-year-old woman with a five-year history of erithema nodosus for which was treated with variable doses of steroids. One year before admission the patient began to complain of headache, amenorrhea and rapidly progressive hypopituitarism. Magnetic resonance imaging showed an expanding sellar mass with homogeneous contrast enhancement while lacking the hyperintense signal of posterior lobe. The MRI findings and the history of autoimmune disease raised the suspicion of hypophysitis. The growth of the lesion and its unresponsiveness to the prolonged steroid therapy made surgery, which is both diagnostic and therapeutic, mandatory. The pathogenesis, diagnosis and management of this unusual clinical condition are discussed.

[Detection of Helicobacter pylori in 201 stomach biopsies using the polymerase chain reaction, histological staining (H&E/Giemsa) and immunohistochemistry]. / Evidenziazione degli Helicobacter Pylori in 201 biopsie gastriche mediante Polymerase Chain Reaction, colorazioni istologiche (EE/giemsa) e di immunoistochimica.

Helicobacter Pylori is believed to be an essential etiologic agent of type B chronic gastritis and peptic ulcer disease in humans. Recent reports have also suggested a role for these organisms in the development of gastric carcinoma and MALT-Lymphoma. A variety of diagnostic procedures are used for the identification of Helicobacter Pylori in clinical samples. 201 gastric biopsy (164 antral and 37 body biopsy specimens) were obtained from 164 patients with endoscopic abnormalities. These samples were studied for the detection of the presence of Helicobacter Pylori by histological staining (EE/Giemsa), immunohistochemistry and PCR by using a primer pair derived from the nucleotide sequence of the Urease A gene of Helicobacter Pylori. Specific amplification of a 411 base pair DNA fragment from all strain of Helicobacter Pylori tested was achieved. Of the 201 gastric biopsy analyzed, 63 (31%) were infected with Helicobacter Pylori on the basis of both histological and immunohistochemical staining, and 81 (41%) were positive with PCR (P < 0.001). Our results support a role for PCR in the rapid and highly sensitive and specific identification of Helicobacter Pylori in gastric biopsy specimens.

[Human subcutaneous dirofilariasis: 8 more cases in Italy]. / Dirofilariasi umana sottocutanea: 8 ulteriori casi in Italia.

Eight new cases of Human Subcutaneous Dirofilariasis due to Dirofilaria repens in subjects aged 14 to 83 years, 5 men and 3 women, are recorded. The patients were living in Piedmont (5 cases), Tuscany (1), Friuli-Venetia Julia (1) and Apulia (1). The nematodes were immature in 6 cases (2 males and 4 females) and adults in 2 (both females). Microfilariae in the uterus of one of them were detected.

The retroangular flap for nasal reconstruction.

Many techniques can be used for nasal reconstruction. This paper describes the preliminary results of our study and shows a one-stage method for partial nasal reconstruction performed with a fasciocutaneous island flap with a retrograde blood supply based on the angular artery. This flap is called the retroangular flap. Six patients had been treated from January of 1993 to January of 1994. The technique is illustrated, and the correlated complications and results are also shown. The flap's color and texture have always been satisfactory. In one patient, the thickness of the flap required a secondary defatting. No sequelae were observed in the donor site.

Spinal meningeal melanocytoma. Case report and analysis of diagnostic criteria.

A case of cervical juxtamedullary meningeal melanocytoma is presented along with results of careful neuroradiological and pathological examinations. The authors review the previous literature and discuss the problems related to the intriguing diagnosis of this very rare entity. CT and MRI show variable appearances due to different degrees of melanization and do not reliably allow us to distinguish meningeal melanocytomas from other pigmented tumors. Pathological examination of the tumor is critical for diagnosis, but it absolutely must comprise electron microscopy and immunohistochemistry. Immunohistochemical and ultrastructural criteria are thus proposed to distinguish meningeal melanocytoma from pigmented meningioma or schwannoma and malignant melanoma (primary or secondary).

AgNORs in ductal breast cancer: correlation with ploidy and S-phase fraction by DNA flow cytometry.

Silver-binding nucleolar organizer regions (AgNORs) have been counted in sections of routinely processed paraffin embedded material. The AgNOR score has been correlated with proliferative activity of various neoplasms. An increase in the AgNOR score can be related to cellular growth fractions or DNA-ploidy. We have examined 301 invasive ductal breast carcinomas by this method. The AgNOR counts were also compared with DNA Ploidy and the S-phase fraction flow cytometry. A positive correlation has been found between the AgNOR score and the S-Phase fraction. These data show cell proliferation. We conclude that AgNOR counting may provide information on breast carcinoma in addition to that obtained from flow cytometric analysis.

[Expression of P53 protein in cutaneous melanoma]. / Espressione della proteina P53 nel melanoma cutaneo.

P53 protein in cutaneous melanoma. We report the results of an immunohistochemical analysis about the nuclear phosphoprotein P53 expression performed on 48 primary and 10 metastatic cutaneous melanoma in order to assess the prevalence of the expression of mutant P53 protein (m-P53) in this skin tumour. In our study m-P53 was found in about 46% of primary tumours without any significant relationship with the corresponding metastatic lesions. Therefore the P53 count in cutaneous melanoma is not a prognostic marker of tumour spread and aggressiveness.