Tall cell variant of papillary breast carcinoma: an additional case with review of the literature.

Papillary lesions of the breast can be one of the most challenging aspects of mammary pathology because of a wide morphologic spectrum that may be encountered in these lesions. An unusual breast tumor has been first classified as "breast tumor resembling the tall cell variant of papillary thyroid carcinoma" and subsequently renamed "tall cell variant of papillary breast carcinoma". To our knowledge, only 13 cases of this neoplasm have been reported so far. Metastasis to the breast is not an uncommon event and about 5% of all such cases are of the thyroid origin. We report the clinico-pathological and immunohistochemical features, together with a molecular screening for BRAF mutations, of an additional case of tall cell variant of papillary breast carcinoma occurring in a 65-year-old woman. The immunohistochemical and molecular clues leading to the correct diagnosis have been correlated with the data of the literature. Tall cell variant of papillary breast carcinoma represents a unique histologic subtype of mammary carcinoma of probably low malignant potential which has to be recognized to avoid misdiagnosis as metastatic carcinoma from the thyroid.

Sustained response following sorafenib therapy in an older adult patient with advanced renal cancer on hemodialysis: a case report.

The prognosis for patients with renal cell carcinoma is very poor, with a five-year survival rate of less than 10%. Sorafenib is an orally administered multikinase inhibitor that blocks intracellular kinases in the Raf/MEK/ERK pathway involved in tumor proliferation, and also kinases responsible for angiogenesis, including VEGFr-2, VEGFr-3, Flt-3, PDGFr-ß and c-KIT. As a consequence of its limited renal clearance, sorafenib appears to be suitable for patients with advanced kidney cancer and terminal renal failure. The case of a 72-year-old male patient on hemodialysis and receiving sorafenib treatment for mRCC is reported.

Primary synovial sarcoma of the kidney. A case report with pathologic appraisal investigation and literature review.

Synovial sarcoma (SS) is a soft tissue neoplasm with clearly defined histologic, immunohistochemical and molecular features that usually arises in the extremities of young adults. The occurrence of these tumors in the kidney is extremely rare and have been prevalently described in case reports. The objectives of this work were to evaluate the frequency of primary renal synovial sarcomas and the pathologic progression in recognition of this possibly under-diagnosed entity. A comprehensive review of the literature has also been performed with a focus on survival. We report the clinico-pathological features of an intrarenal SS occurring in a 67-year-old man. The tumour, measuring 4 cm in its greatest diameter, completely replaced the cortex and the medulla of the inferior region of the left kidney compressing the iliopsoas muscle. Radiological imaging was consistent with a renal cell carcinoma. Histologically, the tumour was composed of atypical monotonous vimentin+, CD99+, bcl-2+ spindle cells exhibiting a haphazard fascicular growth pattern and a high mitotic rate (3 to 5 mitoses per HPF). The diagnosis was supported by reverse transcription-polymerase chain reaction which demonstrated SYT-SSX2 gene fusion. The patient was alive with local recurrence of disease 24 months after surgery. Synovial sarcomas occurring in the kidney, in analogy to other sites, tend to have an aggressive biologic behaviour. Despite being extremely uncommon, with only 44 cases reported to date, they should be included in the differential diagnosis of benign and malignant spindle cell tumours of the kidney. This study also emphasizes the importance of a correct pathologic diagnosis for prognostic and therapeutic implications.

Low doses of alpha 2B interferon in the treatment of hairy cell leukemia: results of treatment and mean follow-up at 18 months in 13 patients.

We treated 13 Hairy Cell Leukemia patients with rIFN a 2b. In case of complete/partial response, the patients were submitted to maintenance treatment, while, in case of minimal/no response, a second induction cycle was administered, followed by a maintenance one. The patients were followed, on an outpatients basis, for 18 months at least, obtaining a 100% overall response rate; one patient had complete response, 7 had partial response, and 5 only minimal response. Six patients (46%) relapsed an average of 13 months after the end of the treatment. The utility of a maintenance therapy is discussed.

A cultural study on corneal explants and clinic assessment of the effectiveness of treating corneal ulcers induced by alkal test with topic aprotinin and fibronectin.

The A.A. studied the effectiveness of colliriums containing fibronectins aprotinin, and fibronectin associated with aprotinin compared to a placebo using 12 rabbits in which a deep corneal ulcer was induced by alkal. The results showed the same effectiveness of the three collyrium versus the placebo there was clinical recovery in all cases and restoration of corneal trasparency for 13 out of 15 treated eyes. Cellular cultures obtained from primary explants of treated corneal cells, compared with non treated groups, gave the same outcome of the clinical's ones.

[The diagnostic difficulties in a case of Behçet's disease]. / Difficoltà diagnostiche in un caso di malattia di Behçet.

Behçet's disease is a chronic, heterogeneous, multisystem disorder caused by a vasculitis involving arterial and venous vessels of all sized. In 1990, a new set of diagnostic criteria has been proposed as a guide to diagnosis of Behçet's disease, requiring the presence of oral ulcerations plus two of the following symptoms or signs: genital ulcerations, characteristics eye lesions, typical skin lesions, and a positive pathergy test. Nevertheless, both clinic and pathologic diagnosis of Behçet's disease remains sometimes very difficult. Diagnostic procedures and therapeutic implications in a case of Behçet's disease are reported and discussed.

[Correlation between the grade of histological malignancy and nuclear positivity using the AgNOR technique in 6 cases of isolated bone NHL]. / Correlación entre el grado de malignidad histológica y la positividad nuclear con la técnica de AgNOR en 6 casos de LNH óseos monolocalizados.

Several reports have shown that the degree of positivity for the AgNOR count can be used to evaluate the aggressiveness of malignancies since it express an increased protein-synthesis activity. This technique was applied to six cases of stage I osseous non-Hodgkin's lymphoma--4 intermediate grade (2 diffuse small, non-cleaved cell and 2 diffuse large, non-cleaved cell lymphomas) and 2 high-grade immunoblastic lymphomas--in order to assess the histologic grade and the number of AgNOR-positive regions. It was noted that survival together with the trend to invade the surrounding soft tissues (i.e., the tumour aggressiveness) correlated with the AgNOR granule count. Both factors were also related with Ki-67 cell-proliferation antibody positivity. Such correlations were even higher than those found with the histologic features conventionally evaluated in the Working Formulation, so they seem to convey more reliable indices of neoplastic growth potential.

Rearrangements on chromosomes 7 and 14 with breakpoints at 7q35 and 14q11 in angioimmunoblastic lymphadenopathy and IBL-like T-cell lymphoma.

In this report we discuss some cases of AILD and IBL-like T-cell lymphomas and attempt to clarify the cytogenetic relationship between these complex disease states. During the period 1980-1987 we have studied No. 6 patients affected with AILD, three of which showed final evolution into Immunoblastic T-cell lymphoma. Cytogenetic studies, carried out on surgical lymphonodal material with histological diagnosis of AILD and leukemic cells obtained from the peripheral blood at the time of diagnosis, were analysed with IBAS 2000 for a computerized analysis, according to ISCA 1978 criteria. We have found similar translocations in three of our patients with AILD and terminal T-cell immunoblastic lymphoma, occurring between chromosomes 7 and 14 with breakpoints at 7q35 and 14q11. The arising of T-cell lymphoma in patients with AILD seems to be related to the presence of clonal cells with abnormal 7:14 translocation, which represent a very sensible marker of clonality desides of T-cell maturational lineage. In our opinion, the forms of AILD with these cytogenetic aberrations are pre-lymphomatous lesions. On the contrary, the lack of such rearrangements is indicative of non-neoplastic patterns.

Cytologic diagnosis and chromosome analysis: sensitivity, specificity, accuracy and predictive value in malignant and benign pleural effusions.

It is often difficult to determine the origin a pleural effusion even if it is very important for prognosis of a patient. We have studied No. 200 patients, affected with nontraumatic effusions, using cytogenetic technics and cytologic examination. Cytologic diagnosis of pleural effusions allows to detect correctly its malignant nature in a percentage of cases ranging, according to various Authors, between 45 and 80%. The main parameters we have considered in our study, in order to value chromosomal analysis as a useful test for malignity in pleural effusions, can be, at least, placed upon those obtained with cytologic diagnosis. Therefore, we think we can consider chromosomal analysis in neoplastic effusions as a useful completion in terms of diagnostic advantage of cytologic diagnosis.

Putative mesothelial cell growth-promoting activity of a cytoplasmic protein expressed by the mesothelial cell. A preliminary report.

Mesothelioma cells produce a cytoplasmic protein unique to primary tumours of the mesothelium which induces the in vitro proliferation of human mesothelial cells in a dose-dependent fashion. When a polyclonal antibody to this protein was added to cultures of human mesothelioma cells, inhibition of their growth occurred. These results provide evidence for a growth-factor-like role of this mesothelial protein that may act through an autocrine mechanism.

Secretory (juvenile) carcinoma of the breast in an adult woman.

A case of secretory (juvenile) carcinoma of the breast is reported in a 31-year-old woman. Secretory carcinoma in adults is rare, only twenty-seven cases previously reported. It is known to have a more favourable prognosis than the conventional ductal carcinoma. The most adequate treatment appears to be a simple mastectomy with low axillary dissection.

Primary renal lymphoma.

A case of primary non-Hodgkin's lymphoma of the kidney is reported. Only 7 previously documented cases have been found in a survey of the relevant literature. Histogenetic hypotheses are reviewed. Ultrasound and computed tomography findings are described and the diagnostic role of these techniques is emphasized.

Breast lobular carcinoma in a fibroadenoma.

Lobular carcinoma arising in a fibroadenoma is a rare occurrence. A case is reported and literature is reviewed. Carcinomas developing in fibroadenomas are not intrinsically different from those not related to fibroadenomas. Prognosis and treatment are the same as for carcinomas of the same type arising outside and independently of fibroadenomas.

Sebaceous carcinoma arising in benign cystic teratoma of the ovary. Case report.

A case of sebaceous carcinoma in a benign cystic teratoma of the ovary is reported. Histogenesis is from adnexal sebaceous glands. Sebaceous metaplasia of either a squamous cell carcinoma or a salivary-gland malignant variant are excluded on histological ground.