Metastasis of high grade renal cell carcinoma, clear cell type, in fibrous dysplasia with superimposed giant cell reparative granuloma.

A case of monostotic fibrous dysplasia in a 54-year-old male complaining of severe pain in the right hip is presented. Imaging findings demonstrated an extremely aggressive lesion involving bones, liver, lungs, and lymph nodes, and suggested the possibility of sarcomatous transformation. Histological examination established a diagnosis of metastatic high-grade renal carcinoma, clear cell type, and demonstrated the presence of superimposed giant cell reparative granuloma. This latter is a rare example of giant cell reparative granuloma arising in a long bone and in association with fibrous dysplasia. The clinical, radiographic, and histopathologic features of fibrous dysplasia and giant cell reparative granuloma are discussed.

Verruciform xanthoma of the oral mucosa. Report of a case.

Verruciform xanthoma is a rare benign lesion of unknown etiology and pathogenesis, although an inflammatory process seems to be implicated in its origin. It usually shows a slow-growing small lesion which can be sessile or pedunculated and has a typical rough and granular surface. A clinical case of an asymptomatic verruciform xanthoma of the ventral surface of the tongue in a 24-year-old male is reported. The lesion was noticed for the first time during a routine dental examination and it appeared as a sessile whitish verrucous lump hard in texture. An incisional biopsy followed by the excision of the whole lesion was performed. The histological and immunohistochemistry examinations were carried out using antibodies CD68-KP1, CD68-PGM1, alpha-1-antitrypsin and vimentin, desmin, cytokeratins, NSE and S-100. Histology showed epithelial degeneration. The connective tissue papillae were entirely occupied by foamy cells that were positive for CD68-KP1, CD68-PGM1, alpha-1-antitrypsin and vimentin and negative for desmin, cytokeratins, NSE and S-100. The foamy cells were characterized by a large granulous cytoplasm and small picnotic nuclei. In accordance with the literature, the immunohistochemistry analysis confirmed that foamy cells are likely to have a macrophagic origin and that epithelial degeneration could be correlated with the pathogenesis of this lesion.

808-nm laser with exogenous chromophores for the treatment of benign oral lesions.

OBJECTIVE: The aim of this study was to verify the effectiveness and safety of the 808-nm wavelength for use on benign lesions of the oral cavity that are stained with toluidine blue solution. MATERIALS AND METHODS: The toluidine blue solution according to Mashberg is used in stomatology for the detection of leuko-erythroplasic lesions. In our experience, we have used it to stain even serous cysts, angiomas, and fibromas. We chose a 808-nm wavelength emitted from a power diode laser, because it is well absorbed by the blue color and barely by the healthy mucosa. The non-contact photocoagulation kept the surrounding borders intact when we used the pulsed-emission, 50 ms 7 W, without anesthesia. No sutures were needed. The leukoplasic borders of the lesions were histologically examined before and after the treatment. RESULTS: The vaporized lesions healed completely in about 5-7 days without any kind of treatment, leaving some slight elastic white scars. A mild edema-erythema followed the treatment for 5-7 days. CONCLUSIONS: The selective results confirm the effectiveness of this therapeutic procedure on pigmented benign lesions, pre-treated with exogenous chromophores and photocoagulated without bleeding, with a minimum energy 808-nm laser.

[Odontogenic myxoma recurring after 11 years: case report and observations on this unusual neoplasm]. / Mixoma odontogeno recidivato dopo 11 anni. Descrizione del caso clinico e considerazioni su una neoplasia rara.

Odontogenic myxoma is usually a benign neoplasm, although it has the ability to infiltrate surrounding tissues thus becoming locally invasive. Furthermore, it has a moderately high recurrence rate and can sometimes display a really aggressive behaviour. An unusual case of a 48-y-old woman in whom odontogenic myxoma recurred 11 years after excision of the primitive lesion is reported. Although rare, the possibility of malignant evolution led us to consider which was the most appropriate management of both the neoplasm and the recurrence. A careful assessment of the clinical, radiographical, tomographical, histological and, if necessary, immunohistochemical features of the lesion allows a distinction to be made between lesions that are only locally invasive and the rarer, more dangerous aggressive lesions. In the first case we suggest that, where possible, a conservative treatment should be preferred, followed by close monitoring of the lesion over time. Since odontogenic myxoma is limited to the facial bones, excision may be uselessly disfiguring, above all in young patients. More aggressive surgical treatment should be reserved for lesions for which there is a strong suspicion of malignant transformation.

Two-year follow-up results of copper bromide laser treatment of striae.

OBJECTIVE: The aim of our study was to follow-up 15 patients with stretch marks treated positively with the CuBr laser (577-511 nm) in 1998-99 and followed-up for 2 years. MATERIALS AND METHODS: The patients were Italian women, young to middle age (average 30 years old), with skin coloration classified as Fitzpatrick II-III. Biopsies were taken on some patients before the treatment and 1 month after the first treatment. Double-blind histological, histochemical and photographic evaluation was performed. Results obtained as well as to the contradictory effects reported elsewhere in the literature were compared. RESULTS: On average, the results were positive and there were some pathogenic considerations that justified the use of laser.

Cytomorphological variations, proliferation and angiogenesis in the prognosis of cutaneous melanoma.

Depth of invasion and stage of the disease are well known prognostic indicators in cutaneous melanoma (CM). However, the role of other parameters, such as the variations in cytomorphology of melanocyte tumours, mitotic activity and angiogenesis is still open to question. The aim of this study was to analyse proliferation by mitotic activity index (MAI) and immunostaining of proliferating cell nuclear antigen (PCNA), and the intensity of neovascularization (microvessel density; MVD) in CM clinical stage I in relation to epithelioid, spindle and nevoid cell type, histological type (superficial spreading melanoma and nodular melanoma), Clark's level and Breslow thickness. Finally, the role of all parameters in the prognosis of CM was evaluated. Statistical analysis demonstrated that cytological characteristics of CM correlate only with Clark's level, while histological types correlate with MAI, PCNA and MVD. MAI and PCNA also showed correlation between groups according to Clark's level and Breslow thickness. Finally, tumour cell PCNA was found to correlate with MVD. Survival of patients with CM correlated significantly with MAI. These results suggest that cytological variation, histological type, PCNA and MVD alone are not independent prognostic parameters, whereas MAI is a potentially important prognostic marker in CM.

Oral and intraperitoneal acute toxicity studies of yessotoxin and homoyessotoxins in mice.

The acute toxicity of yessotoxin (YTX), homoyessotoxin (homoYTX) and 45-hydroxy-homoyessotoxin (45-OH-homoYTX) has been studied in comparison to that of okadaic acid (OA), the main diarrhogenic toxin, both after intraperitoneal (i.p.) and oral administration. After i.p. administration, homoYTX and YTX showed similar lethality (LD(50)=444 microg/kg and 512 microg/kg), higher than that of OA (LD(50)=225 microg/kg), while 750 microg/kg of 45-OH-homoYTX did not cause death. OA induced the already known toxic signs: before death, mice were motionless and cyanotic; small intestine and liver damage were shown at post-mortem. Mice treated with YTX and homoYTX were restless and jumped before death; necroscopy did not show major changes. After oral treatment, 2 mg/kg of OA induced diarrhoea and body weight loss, causing 4/5 deaths; necroscopy and/or histology revealed degenerative lesions to small intestine, forestomach and liver (confirmed by increased plasma transaminase), but no myocardium alterations. On the contrary, the oral treatment with YTX (1 and 2 mg/kg) and its derivatives (1 mg/kg) did not cause any death or signs of toxicity, except some ultrastructural myocardiocyte alterations, adjacent to capillaries, such as cytoplasmic protrusions (YTX, 1 and 2 mg/kg), fibrillar alteration (YTX, 1 mg/kg) or mitochondria assemblage (45-OH-homoYTX). Altogether, our data show that YTX and its derivatives are less toxic than OA after acute oral and i.p. treatments, at doses which may represent up to 100 times of the possible human daily intake.

[The Pathology museum of Trieste. From medical arachaeology to revitalization]. / Il Museo "Patologico" di Trieste. Dall'archeologia sanitaria alla rivitalizzazione?

Abandoned in the attic of Trieste's Ospedale Maggiore--which since 1872 housed the hospital's Department of Pathological Anatomy, then known as the Prosettura--is a "museum" of pathology that comprises a heterogeneous collection of anatomic specimens: traumatic, inflammatory and neoplastic lesions, as well as specimens of tattooed skin and hymens. All this material, most of which dates back to the end of the nineteenth and to the start of the twentieth century, will soon be recovered and displayed in a museum. Because this operation has given rise to an interesting discussion on the very significance--both present and past--of this kind of museum, we believe it necessary to extend the debate to those in charge of similar collections and to all our colleagues in the medical profession. It is our opinion that this operation may be justified and meaningful, provided that each specimen is presented with adequate reference to its historical and scientific context.

[Pseudolymphoma of the breast involving the periareolar area]. / Pseudolinfoma della mammella a sede periareolare.

Pseudolymphomas are a group of lymphoproliferative disorders which are difficult to classify and diagnose. They can affect several anatomical sites and, among these, a mammary localisation is considered rather rare. Pseudolymphomas of the breast carry an excellent prognosis, and no case of malignant degeneration has ever been described. On the contrary, cutaneous pseudolymphomas, which are considered very low-grade lymphomas by some authors, are actually able to progress to overt cutaneous lymphomas in a minority of cases. The authors present three cases of periareolar pseudolymphoma of the breast. The first two were characterised by the presence of an elevated serum antibody titer to Borrelia, and were therefore diagnosed as lymphocytoma cutis, a disorder affecting 0.6-1.3% of patients with Lyme's disease. Both cases had a benign clinical course, as confirmed by the negative follow-up after more than three years. On the contrary, the third pseudolymphoma, classifiable as an idiopathic form, relapsed locally after ten years, thus testifying to the benign nature of the lesion, but also demonstrating that the lymphoproliferative process may still be active after a long period of time. The last case emphasizes the need for long-term follow-up of these patients.

Malignant pleural mesothelioma following chemotherapy for breast cancer.

Although the induction of malignant mesothelioma by radiotherapy, used alone or in combination with chemotherapy, has been previously reported in the literature, the number of documented cases is extremely small. We report a case of malignant pleural mesothelioma arising four years after chemotherapy for breast cancer in a 42-year-old woman without a history of exposure to asbestos. To our knowledge, this is the f rst reported case of malignant pleural mesothelioma following treatment with chemotherapy alone. It is of interest not only for the patient's young age and the absence of exposure to asbestos, but also for the very short latency period, if compared with asbestos-related mesothelioma.

Masson's pseudoangiosarcoma, alias intravascular papillary endothelial hyperplasia, in dissecting aortic aneurysm caused by cystic medionecrosis.

This report describes a 25-year-old man who died due to extensive cystic medionecrosis of the aortic wall complicated by both an acute and an ancient dissection. The very unusual finding of an intravascular papillary endothelial hyperplasia, also known as Masson's pseudoangiosarcoma, in the dissected wall is reported given its resemblance to a hemangiosarcoma.

The histopathology of non-steroidal anti-inflammatory drug induced gastroduodenal damage: correlation with Helicobacter pylori, ulcers, and haemorrhagic events.

AIMS: The spectrum of microscopic lesions resulting from the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), known as chemical gastritis, remains unclear, and the variable prevalence reported in different studies makes this issue a matter of lively debate. The aim of this study was to evaluate the prevalence and importance of chemical gastritis in patients regularly taking NSAIDs. Owing to the high prevalence of Helicobacter pylori infection, particularly in subjects over 60 years of age, and in view of a possible association with damage, the presence of H pylori infection in the same tissue sample was also determined in all patients. METHODS: One hundred and ninety seven subjects were enrolled, 118 of whom were receiving chronic treatment with NSAIDs and 79 of whom were controls, pair matched for age, sex, and clinical symptoms (ulcer-like dyspepsia or upper digestive tract haemorrhage). Antral biopsies taken during upper gastroduodenal endoscopy were assessed for chemical gastritis according to a modified version of Dixon's score, and for Helicobacter correlated chronic active gastritis, according to the updated Sydney system. RESULTS: Chemical gastritis was identified in 11 patients taking NSAIDs (9%) and in four controls (5%) (p < 0.05). Helicobacter pylori was detected in 53 patients taking NSAIDs (45%) and in 34 controls (43%). Patients taking NSAIDs had a significantly higher number of erosions and ulcers and worse endoscores than controls. The presence of H pylori did not appear to increase histological damage, ulcer prevalence, or haemorrhagic events. CONCLUSIONS: Chemical gastritis is present in a limited number of patients regularly taking NSAIDs, and is not strongly correlated with NSAID induced damage. In many cases of peptic ulcer or upper gastrointestinal bleeding in patients taking NSAIDs, the presence of chemical gastritis or H pylori infection cannot solely account for the development of mucosal damage.

Gastric epithelium proliferation in early Hp+ and Hp- gastritis: a flow cytometry study.

BACKGROUND: Helicobacter pylori increases cellular turn-over causing hyperproliferation and possible assumption of neoplastic characteristics by the gastric epithelial cells. To verify whether patients at risk of cancer can be identified at the very first stages of gastric disease, we studied a sample of patients affected by early Hp+ and Hp- gastritis by flow cytometry and assessed the methods commonly adopted to study gastric cell proliferation. METHODS: 48 fresh biopsies taken from the gastric antrum and body of 24 patients who had undergone endoscopy for dyspepsia, and 48 paraffin-embedded antrum and body biopsies taken from the files of our Department were studied by flow-cytometry. The following markers and parameters were considered: S-phase, proliferation index, PCNA and ploidy. RESULTS: No correlation was found between Hp+ or Hp- gastritis and gastric cell proliferation and no cases of aneuploidy were observed. Gastric proliferation was found to vary depending on the methods, markers and type of biopsy employed. Furthermore, proliferation expressed by PCNA was significantly different in antrum and body. CONCLUSIONS: The commonly studied proliferation markers do not allow the early detection of patients at risk of gastric cancer by flow cytometry. Proliferation differences between body and antrum must be taken into account in the investigation of gastric diseases.

Cutaneous pseudolymphoma of the breast with late homozonal relapse.

Cutaneous pseudolymphomas refer to a group of lymphoproliferative disorders of difficult classification and diagnosis. Considered as very low-grade lymphomas by some authors, they are actually able to progress to overt cutaneous lymphomas in a minority of cases. We report a case of cutaneous pseudolymphoma of the breast in a 21-year old woman which relapsed locally ten years later. The case is of interest for the unusual localisation of the lesion, for its recurrence after such a long period of time, and for the homozonal site of recurrence. The reported features support both the long course and the lymphomatous nature of such lymphocytic proliferations.

Diabetes mellitus and oral disease.

The oral complications of diabetes mellitus are generally considered to be no more than inevitable annoyances and, as such, have been the subject of relatively few scientific and clinical studies. This review highlights both the known correlations between oral disease and diabetes mellitus, such as those involving supporting tissues and oral mucosa, and those that are still a matter of debate, such as dental caries. In all cases, we carefully analyzed the pathogenesis of the disorder with a view to establishing a possible therapeutic approach, an aspect that currently appears to be overlooked. In view of the fact that the treatment of certain oral conditions, in particular periodontal disease, has been reported to improve metabolic control in diabetic patients, we conclude that diabetes mellitus-related oral diseases deserve adequate recognition and further investigation.