Eosinophilic cytoplasmic inclusions in type 2 papillary renal cell carcinoma.

A case of a patient with type 2 papillary renal cell carcinoma with eosinophilic cytoplasmatic inclusions is presented. About 50% of tumor cells were characterized by a well-circumscribed intra-cytoplasmatic round-to-oval or irregular inclusion/globule. Inclusions were 7-30 micron in diameter. They were glassy and pale to slightly eosinophilic in color in hematoxylin and eosin, were stained red by trichrome and were negative for periodic acid-Schiff reaction. Immunohistochemically, globules were negative for PAX8, epithelial membrane antigen, Carbonic Anhydrase IX, pan-cytokeratin (AE1/AE3), CD10, S100 protein, α-smooth-muscle actin, cytokeratin 7 and cytokeratin 34ßE12. Glassy hyaline globules were not detected in any adjacent normal kidney cells. The presence of eosinophilic cytoplasmic inclusions in renal cell carcinoma, especially in papillary renal cell carcinoma, has been rarely emphasized in the literature. In this article, we review similar cases in the literature and discuss the nature of eosinophilic globules.

A case of placental site nodule associated with cervical high-grade squamous intraepithelial lesion.

INTRODUCTION: A placental site nodule (PSN) is a remnant of intermediate trophoblast (extravillous trophoblast, EVT) from a previous pregnancy. Usually, this a benign lesion, which once removed, does not require any treatment and does not recur. Although this lesion is related to pregnancy, it may be detected many months or several years after the pregnancy from which it resulted. The lesion represents a degenerative process of EVT. Especially in tissue obtained from curettage, can microscopically mimic aggressive lesions of intermediate trophoblast, such as placental site trophoblastic tumor (PSTT) and epithelioid trophoblastic tumor (ETT), and in an unusual location can pose problems in differential diagnosis with other malignancies, as in the present cervical example. CASE REPORT: A 36-year-old female, gravida 2, para 1, with a history of early spontaneous abortion two years prior, was submitted to a cervical smear for abnormal uterine bleeding, which showed a cervical high squamous intraepithelial lesion (HSIL) with extension to the endocervical cells. Histologic examination of the endocervical curettage revealed haphazardly distributed fragments of tissue, showing extensive hyalinization and cells of different size with indistinct outlines, organized in small groups, singly, or in cords. Mitotic figures were absent. Immunohistochemical analysis revealed focal positivity to cytokeratin 8 (CK8) and placental alkaline phosphatase and negativity to high molecular weight cytokeratin. The Ki-67 index was low. As a result, the morphological and immunohistochemical findings led to the diagnosis of a PSN. CONCLUSION: Diagnosis of a PSN in an unusual location also can pose problems in differential diagnosis with other malignancies, as in the present cervical example. In the present case, the cervical location and the association with HSIL might suggest an erroneous diagnosis of cervical invasive squamous carcinoma. Clinical and pathological data, with immunohistochemical study, are mandatory for a correct diagnosis of this lesion.

A case of ovarian psammocarcinoma with homolateral serous cystoadenofibroma and thecoma associated with Brenner tumour and cystoadenofibroma of the contralateral ovary.

Psammocarcinoma of the ovary is a rare serous neoplasm, with only 32 cases reported in the international literature. Characteristically, this tumour shows extensive formation ofpsammoma bodies, low-grade cytological features, and invasion of the ovarian stroma, peritoneum or intraperitoneal viscera. The behaviour of this entity is unpredictable, with benign, low malignant and metastatic potential. Herein the authors report a case ofpsammocarcinoma of the ovary with homolateral serous cystoadenofibroma and thecoma, which were associated with Brenner tumour and adenofibroma of the contralateral ovary, in a 78-year-old woman. Thus, this example shows an unpredictable tumour associated with multiple benign epithelial neoplasms and a benign stromal tumour. Moreover, this example of psammocarcinoma is very interesting because it measures only 1.5 x 0.5 x 1.5 cm and, to the best of the author's knowledge, represents the smallest case ofpsammocarcinoma described so far in the literature.

[Clinical evaluation of the efficacy and tolerability of the ''NoAll Bimbi Pasta Trattante'' barrier cream in napkin dermatitis]. / Valutazione clinica dell'efficacia e della tollerabilità di NoAll Bimbi Pasta Trattante nelle dermatiti dell'area del pannolino.

AIM: Napkin dermatitis or diaper dermatitis is one of the most frequent cutaneous disease in the pediatric age. The most common type of napkin dermatitis is the irritant contact form, which is frequently complicated by an overinfection with bacteria or Candida albicans. METHODS: In this paper, 25 children (7 males and 18 females), aged between 1 month and 4 years and affected by napkin dermatitis, were treated with a barrier cream containing zinc oxide, vitamin E, panthenol (NoAll Bimbi Pasta Trattante, PSN Rottapharm, Milan, Italy). In 20 patients, a diagnosis of irritant contact diaper dermatitis was made, 3 patients suffered from atopic dermatitis, 1 patient was affected by psoriasis and 1 patient presented to a perianal streptococcal dermatitis. A candidal overinfection was diagnosed in 12 patients and was treated with a topical antifungal agent, applied twice daily for 2 weeks. NoAll Bimbi Pasta Trattante was applied at every diaper change. In all cases, we considered 2 subjective symptoms (burning and itching), and 3 objective parameters (erythema, oedema, exudation/vesiculation), at baseline and after 4 weeks of treatment. RESULTS: One patient withdrew the study. In 13 patients clinical healing was observed, 9 patients showed marked improvement, in 2 patients we did not observe improvement. Tolerability was considered excellent in 13 patients, good in 9 and sufficient in 2. CONCLUSIONS: The results obtained demonstrated that NoAll Bimbi Pasta Trattante, applied at every change of the napkin, is very effective and well tolerated in the treatment of irritant diaper dermatitis. Moreover, NoAll Bimbi Pasta Trattante, applied in association with other pharmacological treatments, may accelerate healing in case of overinfection due to Candida albicans and in case of inflammatory dermatoses localized in the gluteo-perineal area.

[Vincristine treatment for function- and life-threatening infantile hemangioma]. / Traitement par vincristine des hémangiomes graves du nourrisson.

AIM: To evaluate the efficacy of vincristine treatment for function- and life-threatening hemangiomas. PATIENTS AND METHOD: Nine infants, eight girls and one boy, received vincristine treatment (VCR) for endangering hemangiomas. In six cases, the hemangiomas involved head and neck in a segmental unilateral or bilateral distribution (3/6 also had laryngeal and 2/6 tracheal location causing respiratory distress, 5/6 had eyelid and orbital involvement); one infant had disseminated neonatal hemangiomatosis (skin, liver, kidney); two infants had liver hemangiomas with cardiac failure. VCR was prescribed after failure of high-dosage corticosteroid treatment in six, and of both corticosteroids and interferon alpha 2b (5 months) in one; two infants received VCR as first line treatment. RESULTS: A dosage of 1 mg/m(2) IV injection was delivered, with weekly injections first, and then tapering, increasing the interval between injections, depending on the clinical response. The nine infants received from 5 to 25 injections (average: 16), for a length of treatment of 1.5-8 months (average: 5.5 months). In seven patients a clear clinical response was observed at the end of the first month of treatment, while a slow protracted response was noted in two. Transient mild side effects were present in four patients. DISCUSSION: Corticosteroid treatment, although a worldwide recognized treatment of problematic hemangiomas, cannot always control the growth of alarming hemangiomas. Interferon alpha 2a and 2b have proven a 90% effectiveness: treatment for cortico-resistant, function- and life-threatening, hemangiomas.

Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis.

BACKGROUND: In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors). OBJECTIVES: To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk) in the treatment of young children affected by AD with acute lesions at the time of examination. METHODS: Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination. RESULTS: At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0.003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18.6; P = 0.001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0.112). CONCLUSIONS: The use of special silk clothes may be useful in the management of AD in children.

Skin signs in anorexia nervosa.

BACKGROUND: Eating disorders are becoming an epidemic in Europe, particularly among young women, but European studies concerning this topic are few. In eating disorders, significant medical complications occur in all of the primary human organ systems, including the skin. OBJECTIVE: The purpose of this study was to improve the knowledge of skin signs in anorexia nervosa (AN) and verify whether cutaneous differences exist between the restrictive type and the bulimic type. METHODS: A noncontrolled clinical study was performed in 24 consecutive patients with the restrictive and the bulimic types of AN in order to verify whether the cutaneous signs are different in the two types. The dermatological examination included the entire skin, oral cavity, hair and nails, with attention to skin pathologies prior to the development of AN. RESULTS: In all the patients, the most frequent skin manifestations were xerosis (58.3%), hair effluvium (50%), nail changes (45.8%), cheilitis (41.6%), acne (41.6%), gingivitis (33.3%), acrocyanosis (29%), diffuse hypertrichosis (25%), carotenoderma (20.8%), generalized pruritus (16.6%), hyperpigmentation (12.5%), striae distensae (12.5%), factitial dermatitis, seborrheic dermatitis (8.3%), poor wound healing, melasma and Russell's sign (4.1%). In the patients with the bulimic type of AN, hair effluvium, acne, gingivitis, nail changes and generalized pruritus were more frequent than in the patients with the restrictive type. Russell's sign and seborrheic dermatitis were exclusively detected in the bulimic type. Hyperpigmentation, striae distensae, factitial dermatitis, poor wound healing and melasma were exclusively observed in the restrictive type. Cheilitis, diffuse hypertrichosis and carotenoderma were more represented in the restrictive type. Two patients with restrictive type of AN were followed up for a period of 3 years. In both, xerosis, cheilitis, acrocyanosis, hyperpigmentation and acne improved in relation to the increase in BMI. Hair effluvium and diffuse hypertrichosis appeared not to be linked to this parameter. CONCLUSION: Skin changes are prevalent among patients with AN. Some changes seem to depend on the type of AN or to be linked to the BMI.

Onychomatricoma: report of three cases, including the first recognized in a colored man.

Onychomatricoma is an uncommon benign tumor of the nail matrix with typical clinical features. We report here 3 cases of onychomatricoma, including the first case in a black patient. In all three patients a presumptive diagnosis of onychomatricoma was made by clinical examination. The affected nails were thickened and showed a marked overcurvature of the nail plate. Frontal view of the nail revealed the presence of small woodworm-like cavities within the nail plate. In all cases the pathology showed multiple fibroepithelial projections that extended into the thickened nail plate. The tumor epithelium was identical to that of the normal nail matrix and keratinized without a granular layer.

Congenital hypertrophy of the lateral nail folds of the hallux: clinical features and follow-up of seven cases.

Congenital hypertrophy of the nail folds of the hallux describes an abnormality of the periungual soft tissues of the big toe characterized by hypertrophy of the nail fold which partially covers the nail plate and is frequently associated with inflammation and pain due to an ingrowing nail. We describe the clinical picture and follow-up of seven patients with this abnormality. In three patients the affected toe showed an asymptomatic, dome-shaped, hypertrophic lip that partially covered the nail plate. Four patients had acute inflammatory changes due to toenail ingrowth, with considerable swelling and reddening of the hypertrophic lip that was painful on pressure. Topical treatment with steroids was useful to reduce inflammation and produced persistent remission in two patients. Follow-up showed a spontaneous disappearance of the hypertrophic nail fold in one of the seven patients. In two patients the hypertrophic lip partially regressed, but remained clearly visible, while in two patients it remained unchanged. In two patients surgical correction of the soft tissue abnormality was necessary due to painful nail ingrowth unresponsive to topical treatment.

Syringoma: a review of twenty-nine cases.

The purpose of our study was to identify the clinical characteristics, epidemiologic data and histologic features in 29 cases of syringoma with a duration of lesions prior to the observation between 1 and 25 years. Only one patient complained of moderate itching. In two cases the lesion was solitary, in another the papules formed a lichenified plaque. In six patients only the eyelids were involved and in two patients a symmetrical localization on the forearms was observed. The other 18 patients showed generalized syringoma, 16 with an eruptive onset, 6 of which were familial. One of our cases showed lesions mimicking urticaria pigmentosa and two patients were affected by Down's syndrome. In two cases, histopathology showed association between syringoma and a melanocytic naevus and in one patient with a solitary lesion a clear cell syringoma was observed.