Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: a series of 25 cases with clinico-pathologic correlations.

BACKGROUND: Pilomatrixoma (PMX) is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians. AIM: We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized. MATERIALS AND METHODS: By fine-needle aspiration (FNA) cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa. RESULTS: Patients affected by PMX were 11 males, 14 females (ratio 1:1.27); the mean age was 32.72 years with age range 3-78 years, being 72% (18/25) of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%), scalp (16%), upper/lower arms (28%), and chest (4%). The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic. CONCLUSIONS: The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.

[Results of intrauterine insemination after induction of multiple follicular growth]. / Résultats de l'insémination intra-utérine après induction de la croissance multiple des follicules (CFM).

The authors used multiple ovulation induction by CC+hMG+hCG and intrauterine insemination with capacitized sperm in 63 women, aged between 22 and 43 (mean age 32.474 +/- 5.364) with primary or secondary infertility of various origins (tubal problems being excluded) to enhance the chances of pregnancy and evaluate the pregnancy rate. Partners were aged between 26 and 47 (mean age 36.571 +/- 6.709). The following parameters were considered in all patients: mean age of the partners of the couple, parity, seminal fluid characteristics, duration of infertility, dose of each drug administered, mean number of ampuls per patient and mean 17 beta-estradiol level at the time of administration of hCG. There were 189 cycles induced and 26 suspended (13.75%) including 7 (3.70%) because of protocol drop-out, 13 (6.87%) because of the development of slight hyperstimulation and 6 (3.17%) because of marked hyperstimulation. There were 27 pregnancies (42.85%), 4 of which ended in miscarriage between 7 and 10 weeks. There were 4 twin pregnancies, i.e. 14.81%. Of the 27 pregnancies, 13 (48.14%) were obtained during the first cycle, 9 (33.33%) during the second cycle and 5 (18.51%) during the 3rd cycle. The rate of pregnancies per cycle was 14.89%. With regard to 17 beta-estradiol levels at the time of administration of hCG, 18 pregnancies (69.23%) were obtained in patients with a 17 beta-estradiol level > or = to 1300, 7 (25.92%) in patients with a 17 beta-estradiol level > or = to 1000 and < or = to 1300 pg/ml and 3 (11.11%) in those with a 17 beta-estradiol level < or = to 900 pg/ml.

[Results of multiple follicular growth with CC + pure FSH + HCG and intrauterine insemination with washed semen]. / Risultati della crescita follicolare multipla con CC+FSH "puro" + HCG ed inseminazione intrauterina con seme capacitato.

The Authors have treated 40 women affected by primary or secondary infertility due to various etiologies (with the exclusion of the tubal factor as cause of infertility) for 123 cycles with clomiphene citrate (CC) 50 mg/daily/6 days from day cycle IV to/days from day cycle IX+pure follicle-stimulating hormone (FSH) 75 IU/daly from day cycle VII day cycle IX and 150 IU/d of pure follicle-stimulating hormone (FSH) from day cycle 10th to day cycle XII/XIII. In all patients human chorionic gonadotropin (HCG 5000IU) was administered when the level of 17 B-estradiol was > or = 900 pg/ml and the follicular diameter > or = 19 mm. After 24 hours from the administration of human chorionic gonadotropins (HCG), the patients underwent intrauterine insemination with washed semen and the insemination was repeated in all patients 24 hours after the first-one. This protocol has allowed to obtain 12 pregnancies (30%); the cancelled cycles were 9 (of whom 5, equal to 4.06%, for mild hyperstimulation and 4, equal to 3.25%, for non compliance). Our results confirm the value of the protocol and the low risk of ovarian hyperstimulation following the use of pure follicle-stimulating hormone (FSH) in association with clomiphene citrate (CC).