Detecting a rare composite small bowel lymphoma by Magnetic Resonance Imaging coincidentally: A case report with radiological, surgical and histopathological features.

INTRODUCTION: Diagnosing lymphoma continues to prove challenging in the clinical practice. Composite lymphoma (CL) is defined by the coexistence of different lymphoma subtypes in the same anatomical location. This condition has seldom been witnessed in the gastrointestinal (GI) tract. We weren't able to find previous cases in the literature about small bowel CL with follicular lymphoma (FL) and classical Hodgkin lymphoma (CHL). Surgery is the treatment of choice to obtain accurate histology, to manage and prevent acute complications. We state that this work has been reported in line with the SCARE criteria. CASE PRESENTATION: We describe an extremely rare case of small bowel CL, presenting as an intestinal bulky mass with circumferential infiltration of bowel loops. The small bowel tumor was incidentally detected by abdominal Magnetic Resonance Imaging (MRI) in a 64-year-old man who suffered from rectal discomfort and non-specific clinical symptoms. After this radiological finding, the patient underwent multiphase contrast computed tomography (MDCT) for initial staging and to study vascular involvement. Surgery was recommended to obtain an accurate diagnosis both due to initial symptoms of the intestinal obstruction and to avoid small bowel complications. The histopathological examination revealed a small bowel CL composed mainly of B cells FL with also CHL components. CONCLUSION: It is important to note that involvement of the proximal ileal loops is very rare in small bowel lymphoma. MRI represents a precious diagnostic tool to evaluate the intra and extramural extent of the tumor.

[Giant and bilateral adrenal myelolipoma. Case report]. / Mielolipoma surrenalico bilaterale gigante. Caso clinico.

The adrenal myelolipoma is a relatively rare benign tumour of adipose cell and bone marrow elements, non functioning and asymptomatic. Giant and bilateral adrenal myelolipoma is quite rare. The Authors report a case of bilateral adrenal myelolipoma, a giant one (> 15 cm) on the left side and a small one (> 4 cm) on the right with constant pain in a 57-year-old man, shown by computerized tomography. The hormonal blood tests were normal. Surgical excision was performed for large left symptomatic mass, by open laparotomy, and biopsy for right minor adrenal lesion. Histology confirmed diagnosis of myelolipoma for both masses. Follow-up to 6-12 months did'nt show any change of the right myelolipoma. The authors agree with the need to remove the giant adrenal myelolipoma, because the lesion > 10 cm have a high risk of cancer and hemorrhagic complication, while for small myelolipoma (< 6 cm) 6-12 months follow-up is the appropriate choice.

Membrane vesicles in ovarian cancer fluids: a new potential marker.

The rate of membrane vesicle shedding by tumor cells is probably related to their invasive capability. In order to verify whether the vesicle amount could be utilized as a marker of different pathologies, we analyzed biological fluids obtained from 33 patients with gynecological diseases. In fluids of benign serous cysts, vesicle content was extremely low; in cystoadenomas and fibromas generally it was low. On the contrary, large amounts of vesicles were found in malignant tumor fluids. Gelatin zymographies showed the presence of MMP-2 and MMP-9 in all vesicles except in those recovered from fluids of some serous cysts. A positive correlation between tumor malignancy and both vesicle-amount and vesicle-associated MMP-2 activity was noticed. We also analyzed vesicle content in ascitic fluids recovered from two carcinomas at different times during clinical treatment. In both cases, tumor progression, not monitored by Ca 125 levels, was pointed out by an increased amount of vesicles in ascites. These findings suggest that vesicle content in biological fluids could represent a new useful marker of tumor aggressiveness and tumor progression.

Ultrastructural and phenotypic characterization of CABA I, a new human ovarian cancer cell line.

We have established an ovarian cancer cell line (CABA I) from ascitic fluid obtained from a patient with papillary adenocarcinoma of the ovary prior to drug treatment. The epithelial origin of the cell line was confirmed by morphology and by immunofluorescence analysis using anticytokeratin antibodies. Ultrastructural analysis revealed a very irregular membrane surface and a clear cytoplasm rich in electron-lucent vesicles. CABA I cells grow rapidly in culture (doubling time 18 h) in an anchorage-independent manner. Exogenously added beta-estradiol and epidermal growth factor (EGF) treatments did not influence cell growth rate. FACS analysis to determine the phenotypic profile of tumor-associated antigen, membrane receptor, and adhesion molecule expression indicated that the cell line was positive for different members of the c-erbB family, for alpha 6 and beta 1 integrin receptors, and intensively positive for HLA class I antigens and the folate receptor. Molecular characterization revealed no mutations for c-myc and c-k-ras genes, but did detect an exon 5 mutation in the p53 gene. CABA I cells grew poorly as heterotransplants in nude mice, and tumors showed long latency periods. Because early (15-20) and late (55-60) passage cells maintain the same growth and phenotypic characteristics, the CABA I cell line might provide a good in vitro model system to investigate the cellular and molecular events involved in ovarian carcinogenesis.

Rare association of human herpesvirus 6 DNA with human papillomavirus DNA in cervical smears of women with normal and abnormal cytologies.

We investigated by nested PCR the possible association of human herpesvirus 6 (HHV-6) and human papillomavirus (HPV) genomes in the cervixes of 109 women with normal and abnormal cytological smears. HPV DNA was detected in 8.33% of 24 women with normal cytologies and in 41.1% of 85 women with abnormal cytologies; the proportion of HPV DNA was directly related to the severity of the lesions. HHV-6 DNA was found in only one patient, who had a cytological pattern of koilocytosis. The HHV-6 genome was classified by restriction enzyme analysis as variant B. The study indicates that detection of the HHV-6 genome in the cervixes of women with a wide spectrum of gynecological complaints is a rare event and rules out the possible association between HHV-6 and HPV genomes in cervical cancer lesions.

[Endometrial carcinoma--stage I. Evaluation of risk and prognostic factors in an analysis of 120 cases]. / Carcinoma dell'endometrio--stadio I. Valutazione dei fattori di rischio e dei fattori prognostici in una analisi di 120 casi.

The Authors report on a series of 120 cases of endometrial carcinoma observed from 1980 to 1989, in the 1st Gynecological Oncology of the Oncological Hospital "M. Ascoli", Palermo. After careful clinical and pathologic review, the cases, subdivided in pre and post-menopausal groups, in order to verify possible differences between the two groups, were evaluated with reference to the principal risk factors and to some prognostic factors. As for the risk factors (old age, nulliparity, obesity, long fertile life, etc.), the data do not differ from the results in the literature. The evaluation of the prognostic indicators confirms once again the close relationship between histologic grade and myometrial invasion of the tumor. They have an important predictive value for prognosis and their knowledge is indispensable for an adequate therapeutic strategy, especially at pathologic stage I. Furthermore, findings show some delay in endometrial cancer diagnosis in the population studied, particularly in premenopausal women. Such delay turns out to be significantly associated with a greater myometrial infiltration of tumor.