Epidural scarring after lumbar disc surgery: Equivalent scarring with/without free autologous fat grafts.

BACKGROUND: To limit epidural fibrosis and prevent scar formation/nerve tethering that may contribute to chronic postoperative pain; some surgeons have utilized epidural autologous fat grafts following lumbar microdiscectomy. METHODS: We investigated the correlation between post-microdiscectomy epidural scarring [including select magnetic resonance imaging (MRI) studies] and clinical outcomes in 36 patients operated for symptomatic. MRI documented L4-L5 and L5-S1 disk herniations with (18 patients) and without (18 patient) the application of free fat grafts. In addition, histological evaluation of the original fat grafts was performed in 4 patients requiring additional surgery. RESULTS: We found no clear association between the use of autologous graft fats and the clinical outcomes in this study. CONCLUSION: In this preliminary study involving only 36 patients, the prospective randomized use of free autologous fat grafts did not appear to influence outcomes following microdiscectomy.

Involvement of E-cadherin, beta-catenin, Cdc42 and CXCR4 in the progression and prognosis of cutaneous melanoma.

BACKGROUND: A key event in cancer metastasis is the migration of tumour cells from their original location to a secondary site. The development of melanoma may be viewed as a consequence of the disruption of homeostatic mechanisms in the skin of the original site. OBJECTIVES: To investigate whether dysregulation of cell motility (Cdc42 expression), escaping the control of cell-cell and cell-matrix interactions (E-cadherin, beta-catenin expression), enhances melanoma progression, and whether chemokine receptors (CXCR4) mediate cell migration and activation during invasion and metastasis development. METHODS: The immunohistochemical expression of Cdc42, E-cadherin, beta-catenin and CXCR4 was investigated in 30 patients with surgically treated nodular melanoma, 18 alive and disease free and 12 with a fatal outcome due to metastatic disease. RESULTS: E-cadherin expression was significantly reduced (P < 0.05) and cytoplasmic beta-catenin was increased in the patients who had died compared with disease-free individuals, while membrane expression of beta-catenin was similar in the two groups. Patients with fatal outcome had increased Cdc42 (P < 0.01) and CXCR4 (P < 0.05). In this group a positive correlation was found between melanocytic Cdc42 expression and Breslow thickness (r = 0.598, P < 0.05) and between CXCR4 expression and Breslow thickness (r = 0.583, P < 0.05). CONCLUSIONS: Findings suggest that primary cutaneous melanoma with a high Breslow thickness is characterized by tumour cells with high motility and invasion ability, in line with the hypothesis that low E-cadherin levels and overexpression of Cdc42 and CXCR4 could be prognostic markers of poor outcome.

Cutaneous carcinomas and preinvasive neoplastic lesions. Role of MMP-2 and MMP-9 metalloproteinases in neoplastic invasion and their relationship with proliferative activity and p53 expression.

BACKGROUND: Metalloproteinases (MMPs) are thought to be involved in the process of destruction of basement membranes and stromal invasion by neoplastic epithelial cells. AIMS: In order to investigate the role of MMPs in cutaneous oncogenesis we studied the expression of MMP-2 and MMP-9 in 34 cases of epidermal preinvasive neoplastic lesions and invasive carcinomas. We also studied their relationship with the expression of tissue inhibitors of MMPs and with proliferative activity and p53 expression in neoplastic epithelial cells. RESULTS: MMP-9 was found to be focally expressed by neoplastic epithelial cells at the infiltrative edges in microinvasive carcinomas and in dyskeratotic foci in Bowen's disease and widely invasive carcinomas. Gradation of Mib-1 positivity and p53 expression was found with increasing abnormality in the spectrum of malignancy. CONCLUSIONS: Our results seem to suggest the involvement of MMPs in microinvasive carcinomas, which show also low proliferative activity and p53 expression, whether other factors seem to be more important in widely invasive carcinomas.

Madura's foot: report of a case caused by Madurella mycetomatis.

We present a case of mycetoma by Madurella mycetomatis on the foot of a Chinese young man, living in Italy for more than ten years. Clinically the lesion closely resembled and was initially misinterpreted as a vascular neoformation. We analyze the histological and morphological features of the Madurella mycetomatis infection through which we managed to type the etiological agent. Our case is worth reporting because of the rarity of this disease in Europe and the unusual clinical presentation. It also offers the opportunity to stress the need for the clinical suspicion of this dermatosis, considering the increase of immigration towards our regions.

Adult rhabdomyoma: report of two cases of rhabdomyoma of the lip and of the eyelid.

We describe two cases of adult rhabdomyoma. One was located in the lip of a 66-year-old woman and was removed because it was clinically suspicious for infiltrating carcinoma. The other arose in the eyelid of a 60-year-old woman with a glass eye and was initially interpreted as a reactive process due to the prosthesis. Both lesions were composed of cells with oval nuclei and deeply eosinophilic cytoplasms with occasional cross striations. Immunoreactivity for desmin and myoglobin excluded the diagnosis of other tumors with similar morphology. The unusual association of the eyelid tumor with the prosthesis suggests a role for chronic irritation in the pathogenesis of rhabdomyoma.

Low dose interferon-alpha2b combined with PUVA is an effective treatment of early stage mycosis fungoides: results of a multicenter study. Cutaneous-T Cell Lymphoma Multicenter Study Group.

BACKGROUND AND OBJECTIVE: The early stages of mycosis fungoides (MF) can be treated but not cured by photochemotherapy (PUVA) alone; some recent studies of the effect of a combination of human interferon-alpha (IFN(alpha)) and PUVA reported a high degree of response. The aim of our study was to evaluate the activity of a low dose of IFN-alpha2b combined with PUVA. DESIGN AND METHODS: Twenty-five patients were included: 16 men and 9 women aged between 23-80 years; 19 patients ahd stage I and 6 stage II disease. In the induction phase, the dose of IFNalpha was gradually raised over 6-8 weeks to the target dose of 18 MU/week; in the maintenance phase, the combination with PUVA allowed IFNalpha to be reduced to a maximum dose of 6 MU/week; in this way the cumulative administration of IFNalpha and PUVA was considerably lower than in similar combination protocols. Treatment success was analyzed in terms of freedom from treatment failure (FFTF). RESULTS: After the induction phase 9/25 patients (36%) achieved complete remission (CR) and 15/25 (56%) achieved partial remission (PR). One to five months from the beginning of the maintenance phase, a CR was recorded in 19/25 patients (76%) and a PR in 5/25 patients (20%) accounting for an overall response rate of 96%. The median of FFTF was not reached; probability of FFTF was 82% at 12 months and 62% at 24 months. Disease free survival projected to 48 months was 75%. INTERPRETATION AND CONCLUSIONS: Even with low doses of IFNalpha plus PUVA it is possible to achieve excellent clinical responses,many of which are long-lasting, in patients with early MF.

Epithelioid haemangioma of the heart.

The authors report a case of epithelioid haemangioma (EH) of the right atrium, the first description of this tumour originating in the heart. The lesion was found incidentally during a cardiac echocardiogram and diagnosed pre-operatively as cardiac myxoma. The tumour must be differentiated from the exceptionally rare epithelioid haemangioendothelioma (EHE) of the heart and from a cardiac myxoma. A correct pathological diagnosis is clinically important since EH is a benign tumour, whereas EHE and cardiac myxoma can recur and metastasize. The uneventful follow-up of this patient confirms the benign nature of EH.

Extraskeletal osteosarcoma of the mediastinum associated with long-term patient survival. A case report.

The authors report a case of mediastinal extraskeletal osteosarcoma showing immunohistochemical and ultrastructural features of epithelial differentiation and associated with a long-term patient survival. The possible role of flow cytometric DNA analysis in defining the prognosis of this tumor is discussed.

Gastric dysplasia: a ten-year follow-up study.

The results of a ten-year follow-up study on gastric dysplasia (GD) are reported. A total of 260 cases were diagnosed, 125 of which had an adequate follow-up, 81 Low Grade Dysplasia (LGD) and 44 High Grade Dysplasia (HGD). Patients with LGD were younger than patients with HGD, while no significant difference in the mean age was found between HGD and carcinoma. LGD regressed in 49.4% of cases, persisted in 18.5% and progressed in 32.1%. HGD regressed in 4.6%, persisted in 13.6% and progressed in 81.8%. In some cases dysplasia reappeared after a long-time interval of apparent regression. In 58 cases progression to cancer was observed: in 35 cases dysplasia was associated with carcinoma (8 LGD and 27 HGD), while in 23 cases dysplasia evolved into carcinoma (14 LGD and 9 HGD). There was a good correlation between the accuracy in following up the patients and the chance of diagnosing the carcinoma at an early stage. The importance of gastric dysplasia as a marker for carcinoma, its precancerous nature and the treatment of the patients are discussed.

Gastric duplication communicating with a pancreatic duct. Report of a case.

A case of gastric duplication communicating with the pancreatic duct system is reported. The clinical presentation consisted of abdominal pain with recurrent acute pancreatitis. The histopathological examination showed that the duplication was lined with normal pyloric mucosa. In the tubular structure, connecting the duplication to the pancreatic ducts, an increase in the number of serotonin-positive cells was found. The pancreas showed dilatation of the duct system and chronic pancreatitis.

Quantitative evaluation of recurrent meningiomas.

Clinical, histological and karyometric parameters, nuclear DNA content and the number of nucleolar organizer regions were investigated in 9 recurrent meningiomas and 10 meningiomas which had not recurred within a 10-year period. There were no significant differences between the two groups as to age, sex, site of the tumours and most of the histological parameters scored. Recurrent tumours showed a higher number of mitotic figures and the nucleolus was visible in most of the cells. Cell density, nuclear area, perimeter and nuclear DNA content had values with no statistically significant differences between the two groups. However, significant differences were found in the distribution of the nuclei in the different ploidy regions. Most of the nuclei in the non recurrent cases were in the diploid range, whereas in recurrent tumours there was a reduction in the number of diploid cells associated with an increase in 2c--4c and 4c components. Recurrent tumours also showed a higher number of nucleolar organizer regions positively stained using an argyrophil method. The mitotic count and the nucleolar organizer regions appeared to be the best predictors for recurrence.

[Nephrogenic adenoma. Presentation of 7 cases]. / Adenoma nefrogenico. Presentazione di sette casi.

Nephrogenic adenoma is a vesical lesion of uncertain pathogenesis. Histologically it is characterised by glandular-like aspects that take on the form of tiny tubules consisting of a single layer of cuboidal or columnar epithelium. The lesion was first described by Davis in 1949 and a year later Friedman and Kuhlembeck coined the term nephrogenic adenoma. Personal experience with seven cases of this lesion is reported here. Six of the seven cases occurred in the bladder, the remaining one in the prostatic urethra. Four patients reported prior surgery of the urinary ways, three suffered from recurrent cystitis, one had bladder stones while three were being followed up in our department for urothelial carcinoma. Diagnosis of nephrogenic adenoma was based on histopathological examination carried out on biopsy samples taken during urethrocystoscopy. The urothelial lesions were subjected to transurethral resection or endoscopic diathermocoagulation. All patients are being followed up and no recurrences have yet been reported.