Skin and thigh muscle metastasis from papillary thyroid cancer.

A 44-year-old man with total thyroidectomy for papillary thyroid carcinoma (PTC) performed at the age of 38 years was referred for mediastinal metastases demonstrated on chest radiograph and high serum thyroglobulin (Tg 328 ng/ml). Computed tomography revealed mediastinal lymph node enlargement with left bronchial compression and reduction of bronchial diameter, as well as two metastases in the left lung. Bronchoscopic biopsy findings showed a poorly-differentiated PTC, while a whole body scan after 131-Iodine therapy demonstrated uptake in the right subclavicular region. External beam radiotherapy and chemotherapy yielded no benefit; the neoplasm was aggressive, diffuse and experienced fast growth, leading to the formation of metastases also at unusual sites, such as the skin and thigh muscle. The patient died from a brain metastasis. We report a rare case of PTC metastasis with a poorly-differentiated component in a young patient. Rapid and diffuse metastases also to unusual sites led to death eight years after the initial diagnosis and treatment.

Immunohistochemical study of apoptosis markers and involvement of chemokine CXCR4 in skin Merkel cell carcinoma.

BACKGROUND: Merkel cell carcinoma (MCC) is a rare, aggressive cancer of the skin that mainly affects elderly patients. Because of its rarity, there is no established treatment or proven markers to guide therapy or prognosis. Immunohistochemical expression of apoptosis proteins is considered a useful marker of both malignancy and tumour progression. Apoptosis plays a fundamental role in skin homeostasis, and apoptotic cells have been detected in normal and diseased skin. Chemokines possess a wide range of biological activities and CXCR4 is expressed in some cancer cells, where it plays an efficient role in metastasis formation. OBJECTIVE: To identify immunohistochemical parameters that can help clinicians select the most suitable therapy for skin MCC. DESIGN: Antibodies against ki67, bcl-2, p53, survivin, p16 and CXCR4 were tested to assess the usefulness of these antigens as indices of proliferation potential and predictors of prognosis. METHODS: Immunohistochemical detection of apoptosis inhibitors and CXCR4 was performed on tissue from 12 patients with primary MCC. After excision of the primary lesion, five survived and had no metastases, and seven experienced local recurrence or lymph node metastases. RESULTS: Expression of ki67 and survivin was increased in patients with local recurrence or metastasis (retrospectively classified as 'poor prognosis') compared with those with a 'good prognosis', and bcl-2 expression was significantly greater (P=0.003). P53 and p16 immunostaining was moderate in both groups. A positive correlation was observed between survivin and mutant p53 in the poor prognosis group (r=0.593, P=0.033; regression coefficient). High values of p53 were measured in patients with high levels of survivin and vice versa. CXCR4 was not detected at all. CONCLUSIONS: Our results show strong MCC cell apoptosis inhibition and a high cell proliferation capacity. The positive correlation between survivin and p53 may be a predictor of MCC spread via the lymphatic network. Absent CXCR4 expression may reflect a less aggressive form, with less efficient development of distant and non-organ-selective metastasis formation.

Recurrent epithelioid angiosarcoma of the scalp simulating melanoma. A 10-year follow-up.

We present a case of an intriguing mesenchymal neoplasm of the scalp that recurred several times over 10 years before a final diagnosis was possible. The case was sent for expert opinions to various international dermatopathological authorities and was, for a long time, unanimously interpreted as malignant melanoma. This diagnosis was supported by immunohistochemical examinations demonstrating S-100 positivity. Nevertheless, the clinical behaviour, as well as some histopathological features raised doubt regarding the diagnosis. Only after the last recurrence, followed by a repeat extensive immunohistochemical study, the diagnosis of epithelioid angiosarcoma was made. Histologically malignant melanoma can be highly misleading and in literature, reports of misinterpreted cases of melanoma are published. In contrast, tumours that can simulate melanoma are also not infrequent and it is essential to perform immunohistochemistry to confirm diagnosis and exclude a melanocytic lesion.

[Alclometasone dipropionate (Legederm) for the treatment of steroid-sensitive dermatoses in the elderly]. / Alclometasone dipropionato (Legederm) nel trattamento delle dermatosi steroido-sensibili dell'anziano.

This is a randomized single blind parallel comparison of alclometasone dipropionate cream 0.1% vs hydrocortisone butyrrate in 39 geriatric patients (greater than 60 years old) with steroid sensible skin diseases. The regimen consisted of dosing patients with two applications of the two drugs every day for 4 weeks. Follow-up evaluations have been done weekly, and subjective and objective clinical symptoms, adherence to the study protocol, evolution of the disease, onset of adverse reactions including atrophy have been recorded. Furthermore possible side-effects on hypophysis-adrenal axis have been monitored in baseline conditions, after 7 days and at the end of therapy. In most patients bioptic skin patterns for histomorphometric examination have been drawn before and after therapy to be evaluated by a blind examinator. Alclometasone has reduced initial skin lesions by 82.2%, the extent as hydrocortisone butyrrate. In five patients the complete clearance of the disease has been obtained. Study drugs have been tolerated well by all patients, nor clinical signs of atrophy have been observed. Fluctuations of blood cortisol levels ranged between the normal values. In patients treated with alclometasone histomorphometry revealed a better skin trophism than in patients treated with hydrocortisone butyrrate.

Quantitative evaluation of morphological parameters for infiltrating ductal breast cancer prognosis.

The aim of our study was to determine the parameters intrinsic to ductal infiltrating carcinoma. 42 cases of about the same diameter (greater than 1.5 and less than 2.5 cm) with a minimum follow-up of more than seven years were selected. The nuclear and nucleolar shape parameters of one hundred cells for each case and the DNA content of 100 nuclei were measured by static cytometry. By means of multivariate discriminant analysis, the nucleolus/nucleus ratio and the DNA content proved to be the two best prognostic indicators based only on the examination of the parameters of the primary neoplasia. We were able to correctly classify 90% of the cases, and in particular to assign 100% of living cases and 81% of deceased ones to their exact categories.

Clinical significance of the histomorphometric evaluation of diabetic microangiopathy in the oral mucosa.

Several structural parameters of the capillary vessels were measured in the oral mucosa of patients with diabetes mellitus of type 1 (D.1) and of type 2 (D.2), and of control cases (C), by means of an image analyser in histological sections of routinely processed biopsies. The studied parameters included: a) capillary wall thickness; b) capillary diameter; c) the ratio of capillary wall thickness and diameter; d) capillary wall area; e) capillary area; f) the ratio of capillary wall area and capillary area; g) density of capillary vessels in the lamina propria; h) density of endothelial cells; i) endothelial nuclear area. Clinical and laboratory parameters were also evaluated (duration of the disease, systolic and diastolic blood pressure levels, glycemia, glycosylated haemoglobin, glycosylated albumin, fructosamines, apolipoproteins A1 and B), in order to assess whether a relationship exists with the morphometric parameters studied. Statistically significant differences, at the level of p less than 0.05, were found in the following morphometric parameters between controls and each group of diabetic patients: mean and standard deviation of capillary wall thickness, mean capillary wall area, mean ratio of the capillary wall area and capillary area. A reduction in the capillary density, i.e. the number of capillary vessels per mm2 of lamina propria, was also observed in diabetic patients with respect to the control group, although it was not statistically significant (C vs. D.1: p less than 0.21; C vs. D.2: p less than 0.10).(ABSTRACT TRUNCATED AT 250 WORDS)

Malignant glial tumours: prognostic value of quantitative microscopy.

Nuclear and cell density features have been measured in 22 cases of glioblastoma divided into two groups according to their survival periods, i.e. less than 12 months or more than 12. The results have demonstrated that the logarithmic transformation of the following features show up statistically significant differences (p less than 0.05): mean of the logarithm of nuclear area, standard deviation of the logarithm of perimeter and standard deviation of the logarithm of the roundness factor. The standard deviation of the roundness factor has been shown to be another parameter with statistically significant differences between the two groups. Forward stepwise discriminant analysis was adopted in order to identify the quantitative features which contributed most significantly to discriminating between the two groups. The results suggested a combination of two features, i.e. the standard deviation of the logarithm of the roundness factor and the mean of the logarithm of the roundness factor. The comparison between actual and predicted categories showed 68.18% agreement: 7 out of 22 cases were allocated incorrectly by the computer. However, when a classification probability threshold was adopted, the 7 incorrectly allocated cases assumed an "intermediate" position between the two groups, in agreement with their survival.

Immunocytochemistry of anaplastic carcinoma of thyroid gland.

Twelve anaplastic thyroid carcinomas were investigated with a panel of antibodies. The squamoid and giant cell anaplastic carcinomas showed coexpression of cytokeratin and vimentin in 66% of the cases. Reactivity for A-1-AT and A-1-ACT antiserum appeared when the spindle cell component became prevalent. The antidesmoplakin antibody can be employed on cryostat sections in differential diagnosis between sarcoma and carcinoma of the thyroid.

An immunohistochemical study in thyroid cancer.

Follicular, papillary, anaplastic and medullary cancers of the thyroid were investigated using immunohistochemical methods. The following antibodies were used: anti-S-100, antineuron-specific enolase (NSE), antikeratin, antithyroglobulin, anticalcitonin, anticarcinoembryonic antigen (CEA), antiepithelial membrane antigen (EMA); the following hormones were also tested in the medullary carcinoma: gastrin, ACTH and serotonin. Papillary and follicular carcinoma in particular reacted with anti-S-100 and anti-NSE; the anaplastic neoplasia reacted with anti-S-100 (25%), anti-NSE (12%), antikeratin (12%), antithyroglobulin (12%), anti-CEA (37%) and anti-EMA (37%). Medullary carcinoma reacted with anticalcitonin (100%), anti-CEA (96%), anti-NSE (79%), anti-EMA (4%) and anti-S-100 (17%). We were not able to correlate the virulence of the medullary carcinoma with the anticalcitonin and anti-CEA reactivity, while the hyperplastic C cells were immunoreactive both with calcitonin or with CEA.