Expert pathology consultation through the Internet: melanoma versus benign melanocytic tumours.

Twenty consecutive cases of melanocytic lesions were chosen from the archives of the archives of the institute of Anatomic Pathology at Santa Chiara Hospital, Trento. Representative images were acquired at a spatial resolution of 512 x 512 pixels, saved in IPEG format and delivered to the remote pathologist by multimedia internet electronic mail. Six cases were diagnosed as benign melanocytic lesions by the local pathologist. Of the 20 cases transmitted, each with an average of 5.3 images, the remote pathologist suggested a diagnosis of malignancy in nine cases while 10 cases were thought to be benign. In one case the images were not considered sufficient for diagnosis. Overall, the diagnostic agreement between local and remote pathologist was 79% (kappa = 0.58, P = 0.002). This preliminary study suggest that telepathology by internet electronic mail can be a valuable tool for remote consultation in dematopathology, as well as for other diagnostic fields where expert consultation is necessary.

Spiradenocarcinoma: morphological and immunohistochemical features.

Malignant transformation of spiradenoma is a very rare event and its biologic features have not been fully described. Clinically, these tumours are characterized by the rapid enlargement of a long-standing cutaneous nodule. Microscopic examination discloses the presence of the two components, benign and malignant, whose morphological distinction is not always easy. We report the occurrence of a spiradenocarcinoma within a pre-existing spiradenoma of the cheek in a 48 year old man and review the previously reported cases especially on the basis of their morphological and immunohistochemical characteristics.

[The role of the absolute value and "density" of the prostate-specific antigen estimated echographically in the selection of patients to undergo a biopsy in suspected prostatic carcinoma. A comparison between PSA, palpation and echography in 95 patients undergoing echo-guided endorectal prostatic biopsy]. / Ruolo del valore assoluto e della "densità" dell'antigene prostatico specifico, valutata ecograficamente, nella selezione dei pazienti da sottoporre a biopsia nel sospetto di carcinoma prostatico. Confronto tra PSA, palpazione ed ecografia in 95 pazienti sottoposti a biopsia prostatica endorettale ecoguidata.

We retrospectively reviewed the findings relative to 95 patients with known prostate specific antigen (PSA) values who had undergone digital rectal examination, transrectal US and US-guided biopsy for suspected prostate carcinoma. Histology (48 adenocarcinomas, 26 BPHs, 12 inflammations and 9 negatives) was compared with results from rectal examination, prostate US, PSA values and "density" (PSA/prostatic volume, as measured with US). PSA values < 4 ng/ml exhibited 90% negative predictive value and PSA > 10 ng/ml 70.8% positive predictive value. In the intermediate range (4-9.9 ng/ml) the positive predictive value of PSA was 44.4% and its negative predictive value was 55.5%. PSA density did not affect predictive values in the two groups with PSA < 4 and > 10 ng/ml, while in the intermediate 4-9.9 ng/ml group, positive predictive value raised to 62.5% and negative predictive value to 81.8%, thus increasing the specificity of PSA values and US findings. Our results suggest that PSA should be the examination of choice in the patients with prostatic disease. Follow-up with PSA dosage after one year may be suggested when PSA < 4 ng/ml. PSA density can be helpful in patients with PSA values ranging 4-9.9 ng/ml; biopsy should be performed when the index > 0.15, while follow-up at 6 months should be performed when the index < 0.15. PSA values > 10 ng/ml require further evaluation with rectal examinations, prostate US and US-guided biopsy. Random biopsies are suggested when PSA values are > 20 ng/ml.

[Renal echography in diabetes mellitus]. / Apporto dell'ecografia renale nel diabete mellito.

The US findings in the kidneys of diabetic patients were studied. Diabetic subjects without clinical or laboratory signs of nephropathy were investigated by means of US in order to detect early anatomical lesions predictive of renal injury. The kidneys of cadaver diabetics were also studied to correlate US and histologic patterns. US alterations were observed in half of the cases: they were diffuse in 9% of cases and focal in 39%--hyperechoic spots and hyperechoic juxta-medulla. Focal spots are more common in juvenile-onset diabetics and they are correlated with the age of diabetes. At histology the above US patterns were correlated with the vascular wall alterations typical of diabetic nephropathy. Diffuse alterations are not specific. The authors conclude by suggesting US as a prognostic test for diabetic nephropathy.

[Ovarian metastases of extragenital tumors. Anatomo-pathological contribution to their interpretation]. / Metastasi ovariche da tumori extragenitali. Contributo anatomopatologico alla loro interpretazione.

Ovarian metastases from extragenital malignant tumours. An anatomohistopathologic approach. 102 cases of ovarian metastases from extragenital malignant non hematopoietic primaries have been studied in the Institute of Anatomy and Histopathology of the Trieste University. Breast cancers, followed by colonic, gastric and pancreatic tumours are the most frequent spreading primaries to the ovaries. Generally speaking the ovarian metastases seems to be closely related to the lower age at the tumour onset and to the width of metastatic spreading; this is true mainly for breast and colorectal cancer. These features should suggest that tumour aggressiveness, rather than some tropism of malignant cells, could play the most important role in the metastatic involvement of ovaries. A double behaviour should be instead suggested for gastric cancer: the first one is consistent with those previously described for the other tumours, the second one is related to a less aggressive gastric cancer, arising in the elderly (mean age 73 years old) with isolated involvement of the ovary showing the features of Krukenberg tumours.

Occurrence of liver cirrhosis among autopsies in Trieste.

The reports of 26,879 autopsies performed at the Institute of Pathological Anatomy at the University of Trieste during 1876-85 (70% of all deaths that occurred in the Province) were examined, and 2563 cases of liver cirrhosis were found. Analysis of the sample allowed us to make the following conclusions: (i) The prevalence of cirrhosis at autopsy is high in Trieste and shows no tendency to decrease, as has been inferred by some clinical studies. (ii) The increasing average age at death over the decade studied appears to be unrelated to the new, early treatments adopted for hepatopathic patients, since a similar yearly increase in mean age at death was seen for the whole population of the Province. The combination of a high incidence of cirrhosis and increasing average age of patients will probably result in an increasing occurrence of hepatocellular carcinoma. (iii) The observed male:female ratio (2.3) is analogous to that of alcohol drinkers in the Province and thus suggests a role of alcohol abuse in the development of cirrhosis. The distribution of markers of hepatitis B virus in the population of Trieste, which is very similar in the two sexes, supports this hypothesis.

Comparison between diagnoses on death certificates and autopsy reports in Trieste: gynaecological cancers.

We have compared autopsy results with the diagnosis reported on 759 death certificates for gynaecological cancers. High levels of discrepancies were noted for all sites. Surprisingly, complete agreement between death certificates and autopsy reports was found for only 30% of cervical and corpus tumours and for 50% of ovarian tumours. This low level of agreement was due partly to the poor quality of death certificates of older women. No difference in accuracy was found over the 15-year period considered. The most obvious causes of the discrepancies were of two types. The first was erroneous interpretation of codes; confusion between 180 (cervix) and 182 (corpus) was very frequent. The second type was associated with clinical factors, such as confusion of anatomical site, adjacent organs or metastases being diagnosed as primary tumours. A relatively frequent cause of inaccuracy on death certificates was consideration of patients who had been cured of a cancer as having died of the disease.

[Effect of hysterectomy and ovariectomy on the incidence of malignant neoplasms of the female genital tract]. / Effetto dell'isterectomia e dell'ovariectomia sull'incidenza delle neoplasie maligne dell'apparato genitale femminile.

The true risk population for uterine and ovary cancer have been studied, according to the prevalence of histerectomy and oophorectomy in the Trieste area female population. The calculation of the females at risk for these tumors permits to recalculate the incidence rates that are usually underestimated. This adjustment increases the rates in all genital tract tumors from 14% to 18%, but does not modify the relative frequency per age groups or the incidence in the temporal trends. An exception is represented from the uterine corpus cancer in which the correction of the population modifies the temporal trend for the age group over 60 years. The incidences tend in fact to increase significantly more after the adjustment.

[High-risk focal breast lesions in echography and mammography]. / Lesioni mammarie focali ad alto rischio in ecografia e mammografia.

Proliferative breast diseases include a group of lesions which occupy an intermediate position between benign and malignant lesions and are extremely likely to develop into carcinomas. The authors studied 81 patients who had been surgically biopsied on the basis of mammographic and/or US findings. In 33/81 (40.7%) of them proliferative lesions were diagnosed at histology. Mammography was able to identify 18/33 lesions (54.5%) versus US 26/33 (81.8%). On the basis of these findings, a group of patients at risk for cancer could be identified. As a matter of fact, proliferative lesions, especially those presenting with atypical hyperplasia, are associated with a higher risk of developing into carcinomas than those presenting with typical features. For these patients, the authors suggest more frequent clinical and instrumental screening.

[Metastasis from one tumor to another]. / Metastasi di tumore in tumore.

Tumour in tumour metastasis. The occurrence of more than one primary tumour in the same person is uncommon, nevertheless metastasis of one tumour to another is an extraordinary event. The malignant tumour usually metastasizes in a benign tumour, however a metastatic deposit within a malignant tumour is described. In the present study the literature is briefly reviewed and 43 new cases are described: in 38 the host neoplasm is a benign one, and in 4 is a malignant tumour. In the last case the metastases are present both in a malignant and in a benign tumor.

[Condyloma and intraepithelial cervical neoplasms. Epidemiological contribution to their interpretation]. / Condiloma e neoplasie cervicali intraepiteliali. Contributo epidemiologico alla loro interpretazione.

The frequency of condylomatous lesions and of intraepithelial neoplasms of the cervix (CIN) and their possible association in the female population of Trieste have been evaluated. The analysis was carried out on the basis of biopsy samples of the uterine cervix examined at the Department of Pathological Anatomy and Histology of the University of Trieste in the period between 1-1-1983 and 31-12-1987. In the five-year period considered, 272 papillomavirus lesions and 451 cases of CIN were diagnosed. The condylomatous infections were associated with CIN in 48% of cases. An association with CIN 1-2 was encountered in 32.4% and with CIN 3 in 15.4% of cases. CIN 1-2 was associated with condylomatous lesions in 35.2% and CIN 3 in 20.9%. The average age of patients with cervical condyloma was 29.5 years, while that of patients suffering from CIN 1-2 and CIN 3 was respectively 31.9 and 38.7 years. The patients who presented the association between the two pathologies were younger than those suffering from CIN alone: the average age was in fact 28.7 years among women suffering from CIN 1-2 and viral infection and 35.7 in those with condyloma and CIN 3. In the five years examined, a marked tendency was encountered towards an increase in both pathologies examined and this was seen exclusively in the associated lesions.

Correlation between cervical intraepithelial neoplasia and invasive cervical carcinoma on the basis of their frequency in the Province of Trieste (1977-1986).

The Authors report the results of a study on the diffusion of CIN and of invasive carcinoma of the portio in the Trieste population over the 1977-1986 decade. In order to achieve this aim all the bioptical specimens analyzed in the Institute of Pathological Anatomy and Histology of Trieste University were reviewed. Over this period 313 cases of CIN 1-2, 314 cases of CIN 3 and 289 of invasive carcinoma were diagnosed. The average age for CIN 1-2 lesions was 33.5 (range 17-78), for CIN 3 39.9 (range 18-81) and for invasive carcinoma 58.6 (range 26-89). The distribution by age group was markedly different in the three types of lesion dealt with, showing a substantial presence of preinvasive lesions under the age of 50. During the period considered a significant decrease in the incidence of invasive carcinoma was not recorded, in contrast with other reports. This datum may be explained by the fact that the number of women undergoing cyto-oncological screening has not increased over the last decade.

The pathology of optic nerve aging.

The pathology of the optic nerve in the advanced elderly has been investigated at autopsy in a sample of 50 subjects (43 males, 7 females), aged 95-103 years. Septal fibrous thickness and slendering of nerve fibers were the most frequently encountered lesions as well as degenerative processes involving the cribriform lamina. Other significant features included gliosis, demyelination, and corpora amylacea. Complete arteriosclerotic disease was rarely observed. The results of the present study suggest that optic nerve pathology in aged people is almost the consequence of an inadequate blood supply; nevertheless, the degree of these lesions does not seem to parallel that usually observed in other sites particularly injured by ischemic disease.

Ovarian tumours: anatomohistopathological contribution to their interpretation.

The data resulting from an epidemiological and anatomopathological study on ovarian tumours in the Trieste province are presented. 970 cases of ovarian neoplasms diagnosed in the Institute of Pathological Anatomy and Histology of Trieste University over the 1969-1985 period were analyzed: 66.7% were benign and 33.3% were malignant. The crude incidence of benign ovarian tumours was 24.2/100,000 and that of malignant tumours was 12.1/100,000. The incidence rate of the latter standardized on the world population was 6.5/100,000. It is a low level, which does not increase over time. Benign ovarian tumours affect all age groups, while malignant tumours are more frequent among elderly women. In addition, the distribution by age group varies according to the histological type. Among benign tumours, the most frequent are the epithelial ones (over 50% of the total), followed by tumours of germinal origin (27.5%), tumours of the ovarian stroma (21.6%) and those of ovarian non-specific tissues (0.8%). Among malignant neoplasms, epithelial ones are 94.4%, germinal tumours 2.8%, stromal tumours 1.8% and sarcomas 0.9%.