Jejunal perforation secondary to metastatic sarcomatoid carcinoma of the lung.

The Authors present the third case of small-bowel perforation of a metastatic sarcomatoid carcinoma of the lung. A 62-year-old man underwent a right upper lobectomy because of a lung tumour infiltrating the posterior thoracic wall. The histology showed pleomorphic subtype of a sarcomatoid carcinoma (pT3 pN0 cM0). The postoperative course was uneventful and thus the patient received 5 000 cGY over five weeks. After 5 months the patient was admitted to the Surgical Department for acute abdomen. At laparotomy an advanced fibrinous, bile-stained peritonitis secondary to a solitary perforation of the jejunum 50 cm distal to the Treitz were observed. The microscopical examination showed that the perforated mass consisted of infiltration of dischoesive malignant giant cells, highly pleomorphic multi and mononucleated. The immunohistochemistry, performed with multiple keratin antibodies, revealed epithelial differentiation of malignant cells, compatible with a metastatic carcinoma, consistent to the lung primary. In conclusion, according with literature, the small-bowel perforation is a rare presentation of a metastatic lung carcinoma, and particularly of a sarcomatoid carcinoma. It should be considered in differential diagnosis of patients with acute abdominal symptoms especially in those with a previous treated lung cancer. The surgeons should be aware of the poor outcome of these patients and choose a palliative treatment.

Ultrasonography in the study of hepatocellular carcinoma in woodchucks chronically infected with WHV.

The woodchuck hepatitis virus (WHV)/woodchuck system is studied as animal model of human hepatocellular carcinoma (HCC) induced by chronic hepatitis B virus infection. The aim of the present study was the evaluation of ultrasound (US) liver examination in woodchuck as a routine method to detect HCC nodules and to follow their growth. Sixteen woodchucks were included in the study. US liver examination was carried out in all animals using a 5 MHz convex scanner. Macroscopic and microscopic examinations were performed to evaluate the US findings. The lower limit of nodule detection by US examination was a diameter of 5 mm. Macroscopic and microscopic examinations confirmed US findings in 14 of 16 animals (86.6%). No false negative results were obtained. Increase of nodule size was faster in the early phase of tumour growth. Small nodules (16 +/- 5 mm) appeared as hypoechoic lesions with well-defined margins and homogeneous structure. Large nodules (42 +/- 19 mm) appeared as hyperechoic lesions with irregular margins, heterogeneous or of mixed pattern; microscopical examination showed different degrees of necrosis, inflammation and fibrosis inside these latter neoplasms. The hepatitis reaction was conspicuously more severe around HCC nodules. No fibrosis and/or cirrhosis were found in normal liver parenchyma surrounding tumour nodules. On the whole, US appears to be helpful in the diagnosis of woodchuck HCC even at an early stage. Serial US evaluation can be used to study the growth rate of tumour nodules during natural history or experimental HCC treatments in woodchuck.

Effect of hyaluronic acid on human chondrocyte cell lines from articular cartilage.

The effects of hyaluronic acid (HA) derivative on the proliferation and metabolism of human chondrocytes were examined. Cells were obtained from cartilage from metatarsal phalangeal joints of 20 adult humans (aged 22-63) and from femoral knee condyles of 10 subjects (aged 22-77). Chondrocytes isolated by collagenase/Dnase digestion were cultured with addition of different doses of HA for 4 weeks. Morphological studies demonstrated that HA enhanced the adhesion of cells to substrate; HA-treated chondrocytes proliferated better than chondrocytes cultured in HA-free medium. This study shows that HA improves in vitro substrate adhesion ability and proliferative activity of human cartilage cells and that the response to the treatment varies on an individual basis.