Ileal perforation due to ileocecal endometriosis: a case with an unusual clinical and pathological presentation.

A 34-year-old woman, was admitted to the emergency room of our hospital with a history of symptoms of abdominal pain dating back several years and transitorily related to the menstrual cycle. These had worsened in the days prior to admission. Radiological and clinical examinations detected no signs of peritonitis. During exploratory operative laparoscopy, opted for because of persistence and intensification of the abdominal pain, diffuse peritonitis was found due to an ileal perforation immediately upstream of an ileocaecal mass causing a precaecal stenosis. Laparoscopy enabled us to diagnose the preoperatively undetected complication, to perform a through peritoneal lavage and, following minimal conversion by laparotomy, to perform ileocaecal resection, thereby limiting the severity of the surgical trauma. The definitive pathological diagnosis was ileocaecal endometriosis with signs of transmural fistulisation and the presence of endometrial glandular structures in one of the lymph nodes around the lesion. Perforation is a rare complication on those segments of the intestine most often affected by endometriosis, such as the colon and appendix. However, it is even more unusual when it affects the ileum and no other cases have been reported in the literature. Its genesis is attributed to late diagnosis. The pathological findings highlight the particular characteristics of this case. We would stress the pre-, intra- and postoperative diagnostic difficulties encountered and the importance of a thorough anamnestic assessment when making differential diagnoses in women of child-bearing age with abdominal or pelvic pain and perimenstrual symptoms.

Immunologic cell markers of peripheral blood and lymph node lymphocytes in chronic lymphocytic leukemia.

The immunologic phenotype of the lymphocytes of 100 patients with chronic lymphocytic leukaemia (CLL) was investigated. Peripheral blood lymphocytes (PBL) were examined in all cases; in 46 patients with lymphadenopathy, a lymph node was biopsied and the histologic and immunologic patterns were assessed: 24 had a lymphocytic-lymphoplasmocytoid histology and 22 the follicular variant of lymphocytic lymphoma (mantle zone lymphoma, MZL). For comparison, lymph node suspensions from 19 patients with non-leukemic centrocytic lymphoma (CCL) were also studied. Significant differences in the PBL immunologic features were found between stage O and stage I patients. The phenotype of the lymphocytes of patients with lymphocytic histology was similar to that of stage 0 CLL patients, whereas major differences were found between these patients and those with mantle zone histology. This enables these patients to be recognized easily on immunologic grounds.

Acid hydrolases in B-chronic lymphocytic leukemia (B-CLL): a comparison with normal peripheral B lymphocytes and normal B-cell subset with the phenotype of B-leukaemic cells.

The acid phosphatase (AP), beta-glucuronidase (BG), and alpha-naphthyl-acetate esterase (ANAE) distribution and the morphology of stage 0 B-CLL lymphocytes were studied. The results were compared with the same hydrolase equipment and morphology of normal B-cell populations showing the B-CLL-like phenotype, and thus regardable as the possible counterpart of leukaemic cells. The functional and structural characters of the former were strikingly different from those of the latter. In fact the normal B-cell population with B-CLL-like phenotype showed an homogeneous enzyme pattern with predominant ANAE and a strictly lymphocytic cell morphology. In contrast, the leukaemic cells showed various and unrelated morphological and cytochemical features, thus forming apparent subgroups of B-CLL. The development of an irregular "switch on" mechanism in the blocked malignant cell clone, may account for these functional and structural maturation discrepancies. Moreover, the fact that in the leukaemic cells ANAE activity could be demonstrated only after the appearance of the other hydrolases, makes it a marker of functionally differentiated B lymphocytes.

Signet ring cell lymphoma in salivary gland. An immunohistochemical and ultrastructural study.

A case of recurrent signet ring cell lymphoma involving a salivary gland is reported. The tumour was centroblastic-centrocytic nodular and diffuse. The cells were vacuolated, oil red, Sudan III, PAS and Alcian blue negative. They displayed the Ia-like antigen but were negative for SIg. Ultrastructurally the vacuoles appeared empty or containing residual membrane and/or myelinoid bodies. Sometimes microvesicles were found in them. The vacuoles were mainly located in the Golgi area but they were also found in mitochondria. Cytoplasmic bodies containing microvesicles were also seen. The case is compared with those of the literature and the significance of the vacuoles is discussed.

Prominent plasmacytic differentiation in the recurrence of a parotid immunocytoma. A morphologic and immunohistochemical study.

We report and discuss a case consisting of 2 lesions that developed at different times in the same parotid gland. Although the first lesion showed morphologic features similar to those of the benign lymphoepithelial lesion, a monotypic IgM/K pattern was also revealed by the immunoperoxidase method in its lymphoid infiltrates. Thus, on cytologic grounds, the first lesion was classified as lymphoplasmacytic immunocytoma (according to Kiel criteria). In the second lesion, which recurred 3 years later, the prominent feature was a marked predominance of plasma cells with the same monoclonal IgM/K as the preceding lymphoma. These findings suggests that a B-lymphomatous cell monoclone may undergo morphologic maturation along the lineage of its competence. Secondly, they indicate that every case of benign lymphoepithelial lesion of the salivary glands should undergo thorough immunologic evaluation to exclude the possibility of signs of precocious lymphomatous transformation.

Myoepithelial cells in lobular carcinoma in situ of the breast: a parallel immunocytochemical and ultrastructural study.

The distribution and morphology of myoepithelial cells in one case of normal breast and in 4 cases of lobular carcinoma in situ (LCIS) were studed by immunoperoxidase and immunofluorescence with anti-actin antisera and by electron microscopy. The actin-rich cells appeared to lay flattened on the basement membrane, or perpendicular to it, or appeared dislodged toward the center of the neoplastic ductules in the different cases. It is proposed that the presence of actin-rich cells inside the neoplastic aggregates represents a process of colonization of lobular carcinoma by myoepithelial cells dislodged from the basement membrane; a differentiation of some neoplastic cells toward myoepithelial elements might also be taken into consideration. The features here described could identify a preinvasive stage of LCIS.

Role of the T-cell system in glomerulonephritis induced in rats by human serum albumin (HSA). An immunological and morphological study.

The primary role of the T-cell system in immune-complex glomerulonephritis induced by intravenous weekly injections of human serum albumin (HSA) in rats has been demonstrated. The development of histological, ultrastructural and immunological glomerular alterations which are clearly recognizable in intact animals was prevented by neonatal thymectomy. In vitro tests of cellular immunity (LIF and PHA responsiveness) revealed a close relationship between the involvement of functioning T-cell subpopulations (at least T-helper) and the development of the classic glomerulonephritic pattern. In other words HSA antigen recognition by T lymphocytes, their cooperation with B lymphocytes, and the activation of the latter with related antibody response represent the immunological sequence which leads to the formation of the soluble circulating immune-complexes responsible for the glomerular injury. Our findings suggest that the same immunological sequence can represent the pathogenetic basis for many forms of glomerulonephritis in which T-dependent antigen stimulation is demonstrable. Our data are also discussed in the light of results obtained by others in immuneglomerulonephritis induced in nude athymic mice.

Detection and distribution of alfa-naphthyl acetate esterase activity in thymocytes of normal, myasthenic thymus and thymoma. Histochemical and cytochemical study in relation to E-rosetting.

The extent and distribution of alfa-naphthyl acetate esterase (ANAE) activity in both normal thymuses and thymuses or thymomas from patients with myasthenia gravis were investigated by enzyme histochemistry. In all a closely similar distribution of ANAE activity was recognizable. ANAE positive thymic lymphocytes were distributed preferentially at the cortico-medullary junction and in the medulla. Their numbers at these sites were higher in myasthenic patients than in normal adults (P less than 0.001) and lowest in fetuses. The relative numbers of cells showing both ANAE activity and EN-rosette-forming capacity was lower in thymocytes than peripheral lymphocytes but was increasing higher in thymuses from fetal, adult and myasthenic patients and in thymomas. These findings are discussed in relation to the stage of maturity of thymocytes and the importance of intrathymic immunological challenge in the attainment of these cells of functional properties usually acquired in the periphery.