[Accreditation and certification in pathology]. / Accreditamento e certificazione in anatomia patologica.

The accreditation and certification processes were compared as tools for the management of the Departments of Surgical Pathology and Cytopathology, with references to international and italian experiences.

[Indicators of quality in pathology]. / Indicatori di qualità in anatomia patologica.

Quality assurance indicators are instruments to evaluate and improve the quality of health care. Indicators do not measure the quality but point at the problems. In Surgical Pathology each technique has common or specific Quality Indicators to test the accuracy, the timeliness and the clinical relevance of pathology reports (e.g. Turnaround Time) and, if possible, the adequacy of the supplied services. The author reports the commonest quality indicators in a Surgical Pathology Service.

[Microcystic adenoma of the pancreas. Immunohistochemical and ultrastructural study of 7 cases]. / L'adenoma microcistico del pancreas. Studio immunoistochimico e ultrastrutturale di 7 casi.

Microcystic cystadenoma of pancreas is a rare benign neoplasm with peculiar pathologic characteristics. It is more frequent in women and in elderly age. Macroscopically it is composed of a spongy, microcystic mass with a starry central fibrous core. Histologically serous cysts are lined by cuboidal or flattened epithelium without nuclear atypias and with PAS positive cytoplasms. A surgical conservative approach is the treatment of choice. Seven cases of microcystic cystoadenomas of the pancreas observed within ten years at Osp. San Carlo Borromeo-Milano and Osp. Santa Maria degli Angeli-Pordenone from 6 women and 1 man aged 54-87 years are described. The preoperative and intraoperative investigations that have been necessary for reaching its diagnosis are discussed.

Cervical schwannoma with intranuclear vacuoles by fine-needle sampling without aspiration.

In a 49-yr-old woman who presented with a cervical mass, a fine-needle specimen without aspiration was suggestive of paraganglioma; there were spindle-shaped cells with pseudoacinar structures and prominent intranuclear vacuoles. Subsequent examination of a mass removed from the vagus nerve clearly identified a schwannoma. The differential diagnosis is discussed, particularly in relation to the presence of intranuclear vacuoles, and it is concluded that this cytological characteristic should not in itself define the diagnosis.

Secondary neoplastic infiltration of the myocardium diagnosed by two-dimensional echocardiography in seven cases with anatomic confirmation.

In seven patients with different types of neoplasm, secondary myocardial infiltration was diagnosed in vivo by two-dimensional echocardiography and confirmed by direct inspection. In all patients, clinical and electrocardiographic findings were suggestive but nonspecific for myocardial involvement. Two patients had cardiac tamponade and three had pericardial effusion. In three patients, the echocardiographic diagnosis made it possible to plan specific therapy. Clinical, electrocardiographic and echocardiographic aspects are discussed. A two-dimensional echocardiographic examination should be performed in all patients when cardiac metastatic involvement is suspected from clinical electrocardiographic findings, because the in vivo diagnosis of such a condition may have important therapeutic implications for such patients.

[Electrocardiographic aspects simulating acute myocardial infarct in massive pulmonary embolism. Description of 2 cases]. / Aspetti elettrocardiografici simulanti un infarto miocardico acuto in corso di embolia polmonare massiva. Descrizione di due casi.

Two cases of massive pulmonary embolism, with elevation of the ST segment in the right precordial leads, are reported. In the presence of this electrocardiographic sign, simulating acute coronary insufficiency involving right ventricle, the diagnosis of acute cor pulmonale should be suspected.

[Pulmonary carcinomatosis: a rare cause of acute cor pulmonale]. / Carcinomatosi polmonare: causa inusuale di cuore polmonare acuto.

Five cases of neoplastic pulmonary embolism are reported in whom the clinical presentation was consistent with acute cor pulmonale. Perfusory lung scintigraphy was negative in all the cases. Four patients died within 7 days, one after 30 days from starting of symptoms. At autopsy in all the cases neoplastic diffuse embolization of pulmonary arteries was seen with or without thrombosis. In two cases lymphatic carcinosis was also evident. In the literature the majority of cases are reported to have a subacute clinical course as compared to the acute clinical evolution of our series. We suggest to keep in mind the diagnostic hypothesis of vascular pulmonary carcinosis in the cases of acute cor pulmonale with negative perfusory lung scintigraphy.

[Isolated right ventricular infarct. Description of a case]. / L'infarto ventricolare destro isolato. Descrizione di un caso.

We report a case of extensive isolated right ventricular infarction, which was the result of proximal occlusion of a small right coronary artery in a dominant left coronary arterial system. The diagnosis and treatment of right ventricular infarction are discussed and the literature is reviewed.

In vivo and in vitro evaluation of left ventricular thrombi by two-dimensional echocardiography. Comparison with cineventriculography.

The purpose of this study was to assess the capability of two-dimensional echocardiography to identify left ventricular thrombi as compared to standard single plane cineventriculography in 284 patients, who underwent both procedures within 24 hours for diagnostic purposes. In order to obtain informations about the degree of thrombus organization and diagnostic accuracy of the echocardiographic technique, two-dimensional echocardiographic examinations were also performed in 31 thrombi from 16 autopsy specimens. In 249 cases the results were negative and in 14 cases positive by both techniques. Seven cases were positive by cineventriculography but negative by 2D-echocardiography. In seven cases the findings were equivocal by two-dimensional echocardiography; three of them were negative, two positive, and two equivocal by cineventriculography. In two cases the results were negative by two-dimensional echocardiography but equivocal by cineventriculography. Finally five cases were diagnosed to have a thrombus but two-dimensional echocardiography but not by cineventriculography. In two patients, positive by two-dimensional echocardiography, who were on anticoagulant therapy, follow-up studies showed the disappearance of left ventricular thrombi. In all of them the thrombi showed tissue characteristics similar to those of fresh thrombi examined in vitro. Two-dimensional echocardiography seems to be more reliable than cineventriculography for assessing the presence, extension, number, and morphology of left ventricular thrombi. In vitro studies suggest that two-dimensional echocardiography cannot visualize small thrombi, that fibrotic areas may simulate a thrombus and that in some cases under or overestimation is possible.

A morphologic and permeability study of luminal smooth muscle cells after arterial injury in the rat.

In the carotid air drying model of arterial endothelial injury in the stressed rat, endothelium does not always regenerate over the zone of intimal thickening; instead, a layer of modified smooth muscle cells appears to form a temporary luminal surface. We examined the properties of these luminal smooth muscle cells in injured right carotid arteries from stressed rats at intervals up to 2 months by light, scanning electron, and transmission electron microscopy. Before perfusion fixation, selected animals were given injections of Evans blue dye, ferritin, or horseradish peroxidase. Unlike adjacent endothelium, the luminal smooth muscle cells most closely resembled neighboring intimal smooth muscle cells, lacked morphologic characteristics of normal endothelium, and did not stain with rabbit antibody to rat factor viii. Unlike normal mature endothelium, this layer did not exclude horseradish peroxidase, Evans blue, or ferritin. These data demonstrate that a nonthrombogenic layer composed of modified smooth muscle cells can appear at the luminal surface of a zone of injury-induced myointimal thickening; however, this layer does not form a permeability barrier to large molecules.