Endometrial carcinoma: intraoperative evaluation of myometrial invasion. A prospective study.

AIM: The authors investigated the diagnostic value of intraoperative assessment of myometrial invasion in endometrial cancer patients. Following hysterectomy, the uterus was sectioned and macroscopically examined in order to assess the depth of myoinvasion, which was classified as <50% and >50%. In patients with macroscopic depth of invasion>30% and <50%, a frozen section of this area was carried out. The results of intraoperative evaluation were compared with the results of postoperative pathological examination. The agreement between methods was developed as generalized Kappa type statistic. Sensitivity, specificity, positive and negative predictive values for intraoperative only macro and macro/micro evaluation were calculated. METHODS: Seventy eight consecutive patients (median age 64 years, range 43-92; median Body Mass Index [BMI] 30.5, range 21.9-46.7) who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (THBSO) were included in the study. Following intraoperative macroscopic evaluation, frozen section was carried out in 15 (19%) patients. The median time to obtain the results was 16 min for macroscopic evaluation, and 29 min for the macro/micro assessment. RESULTS: Macroscopic only assessment correctly identified depth of myoinvasion in 91% of patients, while, when the frozen section was carried out, myoinvasion was correctly identified in 95% of patients. For macroscopic only and macro-micro assessment sensitivity and specificity were 76% and 98%, 86% and 98%, respectively. CONCLUSION: These data suggest that the frozen section may improve, the diagnostic value of macroscopic only intraoperative assessment of myometrial invasion in selected patients.

[Pharyngeal and laryngeal hamartoma: case report]. / Amartoma faringolaringeo.

In this report a case of laryngeal hamartoma is presented. Macroscopically this lesion is quite similar to a tumor but is actually a malformation derived from an error in the development of a healthy organ. Histologically, the hamartoma is composed of a proportionally abnormal mixture of tissues as compared to what is normally present in its anatomic site. The lesion is extremely rare and usually appears in the head and neck district, spleen, pancreas, lung and liver. The diagnosis is essentially based on histological examination. The treatment of choice consists of surgery and periodic follow-up. Differential diagnosis must consider other rare neoplasms such as rhabdomyoma and teratoma.

Identification of a functional domain in a GADD45-mediated G2/M checkpoint.

Cell cycle checkpoints are essential for the maintenance of genomic stability in response to DNA damage. We demonstrated recently that GADD45, a DNA damage-inducible protein, activates a G(2)/M checkpoint induced by either UV radiation or alkylating agents. GADD45 can interact in vivo with the G(2) cell cycle-specific kinase, Cdc2, proliferating cell nuclear antigen (PCNA), and the cell cycle kinase inhibitor p21(waf1). The ability of GADD45 to induce a G(2)/M arrest may be caused in part by the inhibition of Cdc2 kinase activity. Here, we report the identification of a region of GADD45 that is involved in this G(2)/M checkpoint. Mutants of GADD45 that lacked either the first 35 or the last 80 residues still retained an ability to induce G(2)/M arrest. A mutant with a deletion of the central region (residues 50-76), which is conserved in the family members GADD45beta and GADD45gamma, lacked such activity. This mutant also lacked an ability to bind to Cdc2, PCNA, and p21(waf1) in vivo. Consistently, either GADD45beta or GADD45gamma bind to Cdc2 in vivo. However, unlike GADD45, neither GADD45beta nor GADD45gamma inhibited the Cdc2 kinase or induced G(2)/M arrest. The unique effect of GADD45 may be caused by the presence of a region containing DEDDDR residues. Alanine substitutions in the region abolished GADD45 induction of a G(2)/M arrest and its inactivation of the Cdc2 kinase but not its binding to Cdc2, PCNA, or p21(waf1). Therefore, the binding of GADD45 to Cdc2 was insufficient to induce a G(2)/M arrest, and additional activity contributed by the DEDDDR residues may be necessary to regulate the G(2)/M checkpoint.

Malignant peripheral neuroectodermal tumor (MPNET) of the kidney.

BACKGROUND: Malignant peripheral neuroectodermal tumors (MPNETs) are primitive neuroblastic tumors that arise, unlike neuroblastomas, outside the autonomic nervous system. A renal origin has been described in very few cases. CASE REPORT: We report the case of a young male patient with a large MPNET of the right kidney, studied with ultrasound and computed tomography before surgical resection. The main radiologic features, the microscopic appearance and the typical immunohistochemical findings, are described and discussed.

Assessment of erythrocyte deformability with the laser-assisted optical rotational cell analyzer (LORCA).

The erythrocyte deformability of 28 patients with anemia was evaluated with the laser-assisted optical rotational cell analyzer (LORCA), an image analyzer that converts into numerical form the degree of refraction of a laser beam induced by red cells subjected to a range of torsional stresses. The patients were 10 thalassemics, including three with intermediate forms (1 HbC/beta degree, 1 homozygote beta for Orkin's haplotype VI, 1 beta degree/beta delta Sicilian type) and seven heteroygotes for beta Th; six with hereditary spherocytosis (including 2 with structural alteration of the spectrin beta chain); three with type II congenital dyserythropoietic anemia (HEMPAS), two hemizygotes and one heterozygote for G-6PD deficiency, and six with severe hypochromic hyposideremic anemia. Red cell deformability was reduced in intermediate thalassemia, hereditary spherocytosis and HEMPAS, normal in heterozygous beta thalassemia and G-6PD deficiency, and increased in hypochromic hyposideremic anemia. These results show that erythrocyte deformability can be impaired by an Hb chain imbalance, membrane and cyto skeleton structure anomalies and changes in the red cell area/volume ratio.

Microvascular changes during laboratory stimuli and structural haemodynamic indices: the role of pulse pressure.

Office and ambulatory pulse pressure have been recognized as independent predictors of cardiovascular mortality and atherosclerosis in hypertensives as well as in normotensives. On the other hand, the vascular reactivity, in subjects with high pulsatile component of blood pressure, has not been studied yet. The purpose of our study was to identify the regional muscular hemodynamics and the cutaneous microvascular changes during laboratory stimuli in young adult very mild hypertensives with high pulse pressure. The cardiovascular (Finapres), the forearm vascular (plethysmography) and the microvascular cutaneous (laser-Doppler flowmetry and transcutaneous oximetry) responses to psychophysiological stimuli were measured. In addition, the hyperemic forearm vascular response to the ischaemic test was measured as haemodynamic index of vascular damage. We studied 15 very mild hypertensives with higher office pulse pressure and 15 patients with similar age, history of hypertension, metabolic parameters and systodiastolic blood pressure but lower pulse pressure values. Patients with high pulse pressure demonstrated reduced hyperemic response and increased residual vascular resistance at the forearm ischaemic test. They did not vary for all the parameters, except pulse pressure, during the baseline period but the total stress response, as residualized area-under-the-curve, was notably different. Patients with higher office pulse pressure demonstrated a significant increased heart rate, systolic and pulsatile blood pressure reactivity. On the contrary, they showed a reduced forearm and cutaneous blood flow response combined to a reduced transcutaneous tissutal oxygenation. The findings suggest that the increased pulsatile component of blood pressure might be associated to structural and functional vascular impairments since the very early stages of hypertension in young adults without metabolic disorders.

Erythrocytes stored in CPD SAG-mannitol: evaluation of their deformability.

The erythrocytes deformability of three blood samples coming from healthy donors has been evaluated by Laser-assisted Optical Rotational Cell Analyzer (LORCA). Blood samples were stored in CPD SAG-mannitol. The study of progressive reduction in the Elongation Index (EI) during the preservation may be used as way of evaluation of erythrocyte vitality in stored blood samples.

Reduced deformability of erythrocytes as feature of congenital dyserythropoietic anaemia type II (HEMPAS).

In this study we report results regarding erythrocytes deformability in congenital dyserythropoietic anemia type II (HEMPAS) by the use of LORCA (Laser-assisted Optical Rotational Cell Analyzer). The reduced erythrocytes deformability observed in seven case of CDA II is caused by changes in the structure of glycoproteins due to the incomplete glycosylation of erythrocytic and erythroblastic membrane. Erythrocytes deformability (EI) was shown to be inversely related with mean corpuscular volume (MCV) and mean haemoglobin concentration (MCH).

Lectin binding properties of bovine resting cartilage.

The aim of this study was to evaluate the differential localisation of glycoconjugates of bovine hyaline cartilage matrix by lectin histochemistry, to compare the results of lectin histochemistry with those that can be obtained in the same tissue with PAS and alcian blue. Frozen and paraffin sections were stained with HE, PAS and alcian blue (pH 1.8). Alcian blue staining was carried out also after 1 and 24 hour digestion with bovine testicular hyaluronidase. Peroxidase conjugated WGA, PNA and RS lectins were tested on all sections before and after 1 hour digestion with bovine testicular hyaluronidase. The results show that all the lectins used in this study react with sugars linked to proteoglycans of territorial matrix, the reaction being increased in territorial, and induced in interterritorial matrix by 1 hour hyaluronidase digestion. Alcian blue at pH 1.8 and PAS were complementary, the former staining territorial, and the latter interterritorial matrix. After 1 hour hyaluronidase digestion, alcian blue stained also the interterritorial matrix. These results suggest that lectins react with low molecular weight proteoglycans and that short hyaluronidase digestion causes depolymerization of high molecular weight proteoglycans without loss of their glucidic components, allowing: a) penetration of alcian blue molecules into the macromolecular proteoglycan network; b) an increase of sugar residuals available for lectin histochemistry. Lectin histochemistry can be useful for differential localisation of glycoconjugates in bovine cartilage, especially if associated with short hyaluronidase digestion and conventional histochemical techniques.

[Histological and immunohistochemical studies in cases of malignant mesenchymal neoplasms of the oromaxillofacial area]. / Studio istologico ed immunoistochimico su alcuni quadri di neoplasie mesenchimali maligne del distretto oro-maxillo-facciale.

The authors present an immunohistochemical study of 11 cases of maxillo-facial primitive sarcomas. Specimens from demoliti maxillary resections were prepared and stained with alpha-1-antichymotrypsin, lysozyme and CD68. Alpha-1-antichymotrypsin confirmed in this study its lack of specificity as a tumor marker being relevated both in fibroblasts and in osteoblasts and even in chondrosarcomatous tissue. The results of lysozyme and CD68 stainings were interesting especially in malignant fibrous histiocytoma (MFH), fibrosarcoma and osteosarcoma. The authors showed, once more, that while in osteosarcoma the markers were noted in osteoclasts or pre-osteoclasts alone and not in the neoplastic stroma; all fibroblastic elements were marked in MFH. Immunohistochemical research of histiocyte-macrophage lineage confirmed its utility in osteosarcoma versus MFH differential diagnosis. In fibrosarcoma, furthermore, the authors obtained a positive staining of CD68 and lysozyme in fibroblastic elements morphologically similar to the other neoplastic cells. This datum induced the authors to formulate the interesting hypothesis that MFH and fibrosarcoma represent the opposite ends of a wide spectrum of differentiation of a single neoplasm of fibrohistiocytic origin.

[Osteomas and exostoses of the facial structures: a morphological study and the etiopathogenetic considerations]. / Osteomi ed esostosi del massiccio facciale: studio morfologico e considerazioni etiopatogenetiche.

The differential diagnosis of the osteocondensing lesions (osteomata and exostoses) is till today a topical issue for the experts. In order to test the reliability of the etiopathogenetic theories advanced up to now, the authors carried out a research on samples of tissue coming from surgical interventions for osteomata and exostoses of the maxillofacial region resortied with optical and polarized-light microscopes (OM-PLM). This research meant to analyze the morphological and structural characteristics of newly formed tissues; a considerable attention has been devoted to the difference between primary and secondary bone and to the quality of cementing lines. Thanks to the data resulted from this study, the authors advanced interesting theories about these pathologies either from an etiological and nosological point of view.