[Coexistence of different histotypes of renal carcinoma:our experience and literature review].

The coexistence of multiple, synchronous primary tumors of different histology within the same kidney is a rare condition. We report herein a series of five patients with two tumors of different histology involving synchronously the same kidney. MATERIALS AND METHODS. We reviewed the pathology reports of a series of 381 patients who underwent surgery for primary renal tumors at our institution from 2000 to 2007. In the files of all patients with synchronous tumors of different histology, special attention was given to the results of imaging studies. RESULTS. Five out of 381 patients (1.37%) had coexistence of two primary tumors of different histology within the same kidney. Four patients had ultrasonography as the first imaging procedure, one patient had ultrasonography as the second imaging procedure; all had preoperative CT of the abdomen. Both lesions were detected by preoperative CT in 4/5 of the cases; in the remaining one, the smaller lesion was not visible, even in retrospect. CONCLUSIONS. The coexistence of multiple and synchronous primary tumors of different histology within the same kidney has been only rarely described. To the best of our knowledge, in literature there are only case reports with the exception of a case of renal oncocytoma with evolving papillary RCC. We believe that this condition could be more frequent if the radiologist and the anatomopathologist try to find it.

Leydig cell tumour-induced bilateral gynaecomastia in a young man: endocrine abnormalities.

Among the various causes of gynaecomastia, testicular malignancies are an uncommon, life-threatening condition, which require prompt treatment. The case of a 26-year-old healthy man is described, who reported a 6-month painful bilateral gynaecomastia associated with secondary hypogonadism. Normal circulating 17beta-oestradiol (E2) levels showed an enhanced response to human chorionic gonadotrophin (hCG) testing, which led to a reduced testosterone (T)/E2 ratio. Both clinical and hormonal findings normalized following surgical exeresis of a left testicular mass, which proved to be a Leydig cell tumour (LCT) at histology. This report underlines the importance of ultrasonographic evaluation of the testes, whenever breast enlargement occurs in a healthy man, despite unremarkable findings on testicular examination. In addition, our case demonstrates that normal unstimulated circulating E2 levels do not allow the presence of a stromal testicular tumour to be ruled out and that the response of restored T levels to hCG testing can remain blunted up to 1 year after surgery. Finally, we claim that T/E2 ratio may be a useful tool in evaluating derangement of the endocrine milieu secondary to LCT.

[Disseminated ossification of the lung]. / Le ossificazioni polmonari disseminate.

Disseminated pulmonary ossification is a rather rare finding. Two classical cases of the dendriform and seven of the nodular one, even if with minimal aspects, were reported. They were found through a revision of 720 postmortem registers and a reexamination of their histological specimens. A typical morphologic picture was observed. About formal genesis of the bone we emphasized the possibility that the ossification occurred in the dendriform also through a cartilaginous phase in addition to a connective one. Various pathological forms of the lung or other organs, that on the basis of the literature are considered responsible or associated with pulmonary ossification, were listed. Eventually, we pointed out that dendriform could be a pathological picture by itself and not a secondary one, that is to say a real idiopathic ossification.

[Stenosing supra-ampullar adenocarcinoma of the second duodenal portion. A rare case of neoplastic pathology]. / Adenocarcinoma sovra-ampollare stenosante della 2a porzione duodenale. Una rara osservazione di patologia neoplastica.

The Authors present a rare case of stenosing primary adenocarcinoma of the duodenum, excluding the papilla of Vater, for its rarity. They report the diagnostic methods and the surgical procedure (D.C.P. resection).

Pigmented papillary carcinoma of the male breast.

A case of highly pigmented papillary carcinoma originating in the breast of a 70-year-old man is presented. The tumor was located in the subareolar region and did not affect the overlying skin, which was normally pigmented. The significance of the presence of melanocytes in the tumor and of melanin pigment in the cytoplasm of its cells is discussed.

Granular cell tumours of the oesophagus and larynx.

Two cases of granular cell tumour of the oesophagus and one case of granular cell tumour of the larynx are reported. The light and electron microscope findings are discussed, as well as the much debated histogenesis of such tumours.

APUD cells of the larynx.

Argyrophil cells and melanocytes were sought with Grimelius' and Fontana-Masson's techniques in 43 specimens of laryngeal mucosa. In 7 cases, melanocytes were found in the squamous epithelium: in only 2 cases, rare argyrophil cells were found in the respiratory epithelium. The demonstration of argyrophil cells in the laryngeal mucosa constitutes the anatomic rationale for the insurgence of carcinoids and oat-cell carcinomas at this site.

Two pigmented lesions of the female genital system. Blue nevus of the uterine endocervix and melanin pigmentation of the vagina.

Five cases of benign pigmented lesions in unusual sites are reported. They consist of four blue nevi of the uterine endocervix, respectively the 38th, 39th, 40th and 41st cases according to our review of the literature, and one melanin pigmentation of the vagina, the 12th case according to our review of the literature. The theories about the presence of melanin-containing cells (melanocytes) in unusual sites are reported and the singular finding of melanin pigmentation observed in vaginal epithelium is discussed.

Melanin pigmentation of the larynx.

Five cases of melanosis of the larynx, verified by biopsy, are reported. All occurred in male patients. Melanocytes and melanin-laden epithelial cells were microscopically seen in the laryngeal mucosa. In one case squamous carcinoma coexisted. Current theories on melanin pigmentation at atypical sites are reviewed.