Inflammatory pseudotumour of the lung. Immunohistochemical analysis on four new cases.

Inflammatory pseudotumour of the lung (I.P.) is a quite rare benign lesion, variously named by different authors. In the present report four new cases of I.P. are presented and immunohistochemically studied with a panel of antibodies. Microscopically, the most prominent histological features were the presence of interlacing bundles of elongated histiocytic-like cells, plasma cell aggregates and lymphoid follicles. Immunohistochemistry showed that plasma cells are polyclonal. The spindle cells were negative for desmin, cytokeratins, lysozyme and S-100 and immunoreactive for alpha-1-antichymotrypsin, vimentin and for smooth-muscle alpha-actin. Actin and desmin, were clearly evident in the vessels' smooth muscle layers, highlighting the angioinvasive behaviour of the lesions. Our data are in keeping with literature suggesting that I.P. is due to a mixed histiocytic-myofibroblastic-reactive proliferation and support the inflammatory nature of IP.

[A case of rhabdomyosarcoma of the parotid region]. / A proposito di un caso di rabdomiosarcoma della regione parotidea.

The present paper reports a case of rhabdomyosarcoma in a 4-year-old patient, the rapidity with which it spread and the intensity of its extension bringing the case under observation. It is, in fact, a case of embryonal rhabdomyosarcoma localized in the right parotid area with an extension to the temporal fossa, to the epi-oro-hypopharynx as far as the lateral vertebral region with C5-C6 involvement and penetrating the medium cranialis fossa. Initially the child showed signs of tissue growth at the right parotid site, originating without symptoms and rapidly increasing in volume. As exploratory surgery revealed that it would be impossible to achieve radical removal of the growth, the authors opted for radio-chemotherapy treatment. This type of approach, however, gives short lived results, in this case evidenced by recurrences within six months and leading to the patient's death after just eight months. It is important to stress the rapid evolution of this neoplasm, its tendency to recur and metastasize as well as its poor prognosis in general.

Hyaluronic acid prevents oxygen free-radical damage to granulation tissue: a study in rats.

Oxygen free-radicals are known to impair wound healing after ischaemia-reperfusion or polymorphonuclear cell stimulation. Furthermore, they reduce the breaking strength of all recent wounds and might be a cause of wound leakage. This study was performed to evaluate whether or not hyaluronic acid can reduce the risk of wound impairment caused by free-radicals, in rats with abdominal sepsis, polymorphonuclear cell stimulation or cytochrome C function derangement produced by xenobiotics. Male Sprague-Dawley rats with open wounds received phenazine methosulfate or zimosan, or had abdominal sepsis to induce oxygen free-radical generation. There were three groups of treatment: hyaluronic acid cream, hyaluronic acid ethyl ester gel, and placebo. The reduction in wound size was measured from the 1st to the 11th postoperative day; biopsies were taken for histological evaluation. Every other day, a gentle debridement was performed in all the groups of animals. We found that hyaluronic acid and its ethyl ester derivative significantly improved the wound healing of rats subjected to an increased generation of oxygen free-radicals. It remains to be established whether or not hyaluronic acid acts as a scavenger of free-radicals.

Large cell neuroendocrine carcinoma of the lung.

Large cell neuroendocrine (LCNE) carcinomas of the lung are a newly recognized, highly aggressive and frequently misdiagnosed entity. We report a case of stage I LCNE lung carcinoma initially misdiagnosed as large cell undifferentiated carcinoma or poorly differentiated adenocarcinoma. The tumor was very extensively necrotic and its neuroendocrine differentiation was only demonstrable with immunohistochemical staining with PHE-5 monoclonal antibody and with antisera against synaptophysin and calcitonin. ACTH, somatostatin and neurofilaments were not demonstrable. The clinical course was ominous and the patient died within 17 months. The reason for this rapid fatal outcome could be ascribed either to the neuroendocrine phenotype of the tumor, or to the extensive necrosis, or both.

Substance P-like immunoreactive nerve fibers of the human laryngeal mucosa--preliminary report.

Substance P (SP) is considered a primary sensory transmitter and is widely distributed within the autonomic nervous system. This study is concerned with the distribution of SP-like immunoreactive nerve fibers in the human larynx. Individual SP-like immunoreactive nerve fibers were detected in the subepithelial connective tissue of the laryngeal mucosa, in the ventricular and subglottic glandular regions and in a few nervous ganglia in the deep connective tissue. No intraepithelial SP-like immunoreactive fibers were present in our material.

[Medical therapy of peptic ulcer: problems and prospects]. / La terapia medica dell'ulcera peptica: problemi e prospettive.

In the last few years, several drugs have been proposed for the healing of peptic ulcers H2 receptor antagonists are probably the reference-drugs for their efficacy and safety. Acute treatment of peptic ulcer with cimetidine, ranitidine or famotidine gives a high healing rate: from 60% to 90%, depending on the location of the ulcer and the drug used. However, relapse after short-term treatment still remains frequent, and prophylaxis of recurrence must be decided. Long-term treatment with antisecretory drugs could be dangerous for changes of the gastric system, with nitrites and nitro-compounds occurrence, and for the risk of frequent relapses. Therefore, the role of mucus-barrier drugs and surgery must be reconsidered.

Mediastinal malignant carcinoid with Cushing's syndrome: immunohistochemical and ultrastructural study.

A case of thymic atypical carcinoid with Cushing's syndrome and unfavorable clinical course is reported. Immunohistochemical analysis reveals distinct staining of tumor cells for ACTH, neuron-specific enolase, chromogranins (CG) and S-100 protein and with PHE-5 monoclonal antibody. At an ultrastructural level, the cells are undifferentiated with only a few neurosecretory granules. In the present case, immunohistochemical stainings for CG and with PHE-5 antibody seem reliable diagnostic tools, easily demonstrating the neuroendocrine nature of the neoplasm. NSE immunoreactivity can be an additional criterion. S-100-positive cells, which are present throughout the tumor, recall 'sustentacular cells', described in other neuroendocrine tumors.

Bronchial carcinoid with S-100 positive sustentacular cells.

A case of double bronchial typical carcinoid of the central type, with a nodal metastasis and paraneoplastic Cushing syndrome is reported. The case is remarkable because both the primary tumors and nodal metastasis were composed of a double cell population: one was arranged in nests, was argyrophilic, immunostained with PHE-5 monoclonal antibody, and contained neurosecretory granules; the other one was neither argyrophilic nor PHE-5-immunoreactive, but was strongly immunoreactive for S-100 protein, had a stellate morphology and was at the periphery of the nests of the other cells. The S-100 immunoreactive cells were regarded as a sort of "sustentacular" or "satellite" cells, which are themselves neoplastic. Bronchial carcinoids with S-100 positive cells, although strictly related with other bronchial carcinoids, may in fact represent a group of tumors with different histogenesis and/or differentiative pattern. More work should be done to elucidate whether there is any relevant clinical difference between bronchial carcinoids with or without S-100 reactive cells.

Neuroendocrine lung structures and tumours: immunohistochemical study by specific markers.

Out of 360 lungs or lobes surgically removed, 13 non neoplastic specimens and 16 neuroendocrine (NE) tumours are investigated with immunohistochemical methods, in order to evaluate the presence of NE structures in normal and pathological human lungs. The markers used are neuron specific enolase (NSE), chromogranin (CG) and the 80 kd antigen (80 kdAg) of NE secretory granules detected by the new monoclonal Phe-5 antibody. In non-neoplastic lung specimens, clearcut immunoreactivity for all three markers appears in NE cells, neuroepithelial bodies (NEB), NE cell-hyperplasias and dysplasias. In the same specimens 4 tumourlets with analogous clearcut immunoreactivities were also observed. The NE tumours show distinct immunoreactivity for all three antisera in the 8 well differentiated cases. The 8 poorly differentiated tumours are variably immunoreactive for NSE and present low to nil staining with antisera to CG and 80 kdAg. The immunohistochemical data are interpreted according to current views about a possible relationship between NE tumours and parent normal NE lung structures.

Pouch ileitis in excluded reservoir: an unusual complication of restorative proctocolectomy for ulcerative colitis.

One case of pouch ileitis after restorative proctocolectomy for ulcerative colitis is described. Diagnosis was made by endoscopy, histology and electron microscopy. The most prominent feature was intense inflammation of the mucosa and submucosa, with atrophy of the villi, and colonic metaplasia, occurring before closure of the loop ileostomy. The patient improved after a course of metronidazole therapy, but ileostomy closure was postponed. It appears that the ileum mucosa of patients with ulcerative colitis is highly prone to the development of inflammation and careful, regular follow-up is recommended.

Prevention of wound dehiscence in severely obese patients with jejuno-ileal by-pass: the role of hyaluronic acid.

There is a high incidence of wound dehiscence, ranging from 6.9% to 22%, after surgery for severe obesity. Different surgical techniques to minimize this drawback of the operation have been proposed, but none have seemed to be really effective. A different approach to this problem has been tried using topical treatment with hyaluronic acid through the drains of the laparotomy suture. Twenty patients subjected to jejuno-ileal by-pass for severe obesity were randomized into two treatment groups: hyaluronic acid (80 mg/daily) or placebo (saline), for 5 days, starting at the operation. Granulation tissue was withdrawn from the wound through polyvinyl catheters 1, 3 and 5 days after the operation. It was processed for light, scanning and transmission electron microscopy. Ten days after the operation, the wounds were examined for dehiscence. Hyaluronic acid treatment reduced the incidence and degree of dehiscence macroscopically, increased the maturation of granulation tissue during the first post-operation days and stimulated fibroblasts to synthesize procollagen shortly after the operation.

Histological and immunohistochemical features in chronic delta hepatitis.

Forty-six liver biopsies from HBsAg Delta/anti-Delta serum positive patients with chronic hepatitis were compared with liver specimens from HBsAg positive Delta/antiDelta negative patients. The results indicate more severe histologic damage and inflammation among subjects who are serum-positive to the Delta system. Specific virus antigen was found in liver cell nuclei of almost all the Delta IR patients (93.5%). The rate of diffusion was directly proportional to the severity of histological lesions, which is in linea with the direct cytopathic effect of the Delta virus as ascertained in various other studies.

Prevention and early diagnosis of cancer in the rectal stump of ulcerative colitis patients after colectomy and topical treatment.

Ulcerative colitis with malignant degeneration and dysplasia can be a precancerous lesion. Therefore, it is necessary to prevent or, at least to diagnose as early as possible any development toward neoplasia in the colon or rectum of the colitis patients. The only reliable guide for a risk of malignant tissue degeneration is dysplasia of the mucosa. A group of 31 patients was studied after total colectomy with ileorectal anastomosis and subsequent topical treatment with enemas containing sulphasalazine and corticosteroids. Two of these patients had mild rectal dysplasia before surgery, seen in a biopsy specimen obtained endoscopically. All the patients were followed for a long time after surgery, with endoscopy and microscopic and ultrastructural observation of rectal biopsy material taken from different sites in the mucosa, both from areas that looked dysplastic by endoscopy and from those that appeared normal. The two patients with presurgical dysplasia, when examined later, one 12 months and one 18 months after surgery, had no rectal dysplasia; the mucosal covering was moderately complete and the anastomosis was functioning. It is considered that to prevent development of cancer in the rectal stump, colectomy should always be followed by regular topical treatment and there should be a check-up at short intervals for early diagnosis of any premalignant areas that might develop. Regression of such lesion was observed to lesser degrees after continuous treatment with the topical medication.

Neuroendocrine structures in normal and diseased human lung.

The increasing amount of histological, immunohistochemical and ultrastructural information on some endocrine secretions in human lung cancers suggest the need to revise the classification of neuroendocrine lesions on surgical material. The aim of the present investigation based on lung specimens removed surgically is to give further support to recent proposal for an updated classification of neuroendocrine lung carcinomas. Our study includes 58 squamous cell carcinomas, 58 adenocarcinomas, 6 large cell carcinomas, 27 neuroendocrine carcinomas, and 30 nontumourous cases. Using histological methods (HE, Alcian PAS, Grimelius silver impregnation), we illustrate the presence of neuroendocrine cells and neuroepithelial bodies with their pathological evolutions, ranging from hyperplasia, to dysplasia, and overt neoplasia. On the basis of our experience we propose the following classification of neuroendocrine carcinomas (NEC): typical carcinoids (NECNID), peripheral carcinoid or well-differentiated NEC (NECWED), NEC of intermediate or poorly differentiated type (NECINT) and NEC of small celled or microcytoma type (NECMIC).

Immunological features of nonhealing midline granuloma.

A 60-year-old man affected by nonhealing midline granuloma (NHmG) is described. The histopathological features, the clinical course and the radiosensitivity of the lesion clearly differentiate this pathological condition from malignant lymphomas and from Wegener's granulomatosis (WG). The presence of antinuclear antibodies with an antinucleolar pattern in a subject bearing HLA-B8 suggests the involvement of autoimmune phenomena and a close relation between NHmG and WG.