Primary sclerosing encapsulating peritonitis: a case report.

BACKGROUND: Sclerosing encapsulating peritonitis is a rare condition with a typical macroscopic appearance, with fibrocollagenous membrane enclosing loops of the small intestine, causing intestinal obstruction. Unexplained recurrent abdominal pain, obstruction, and a large array of other possible clinical signs and symptoms make sclerosing encapsulating peritonitis a diagnostic challenge. CASE PRESENTATION: A 48-year-old man of Persian ethnicity was admitted multiple times to the emergency surgery department due to recurrent sudden abdominal pain and chronic obstruction without significant findings in medical history or clinical evaluation. Computed tomography was positive for proximal jejunal dilatation and duodenojejunal flexure stenosis due to internal mesenteric hernia. Exploratory laparoscopy, followed by laparotomy, confirmed thick membrane-like fibrous tissue with complete small intestinal loop envelopment. Extensive membrane excision and adhesiolysis was performed, but no mesenteric herniation was found. Early postoperative paralytic ileus with introduction of low-dose steroid therapy, based on histopathological and immunological results, confirming type III sclerosing encapsulating peritonitis, was completely resolved. CONCLUSION: Sclerosing encapsulating peritonitis is a rare and difficult-to-diagnose condition, further divided into primary and secondary sclerosing encapsulating peritonitis, on the basis of underlying etiology, dictating treatment modality and prognosis. Intraoperative diagnosis and surgical treatment are mandatory, besides a wide variety of abdominal computed tomography scans, inconclusive results, and clinical presentations. There are so far no known specific markers for the diagnosis of sclerosing encapsulating peritonitis.

Influence of gross specimen sampling on the incidence of incidental prostatic carcinoma in cystoprostatectomy specimens of patients with bladder carcinoma.

Reported prostate cancer incidence rates vary greatly among cystoprostatectomy samples. We investigated how the thoroughness of prostate sampling influences prostatic carcinoma incidence in bladder cancer patients. In a retrospective study, 313 cystoprostatectomy cases of urinary bladder carcinoma were analysed for the presence of concurrent prostatic carcinoma. Patients were divided into two groups: patients who had undergone the operation before and after 2007, when a policy of preferably complete prostate sampling in cystoprostatectomy specimens was introduced at our institution. Cases processed after the 2007 recommended sampling changes had a significantly higher rate of incidental prostatic carcinoma and clinically significant prostatic carcinoma than the pre-2007 group (p < 0.0001 and p = 0.003, respectively). Complete prostate processing in cystoprostatectomy specimens results in a higher incidence of incidental prostatic carcinoma than with partial processing. More patients with clinically significant prostate cancer are consequently discovered. In conclusion, we believe that complete prostate sampling should be mandatory.

Inflammatory myofibroblastic tumour of paranasal sinuses with fatal outcome: reactive lesion or tumour?

Inflammatory myofibroblastic tumours (IMTs) are clinicopathologically distinctive but biologically controversial entities, which have been described in the lungs, abdomen, retroperitoneum, and extremities, but rarely affect the head and neck region. IMT usually follows a benign clinical course after radical excision, but invasive, locally recurrent, and metastatic forms of abdominal and mediastinal IMT have also been described. This report describes a case of IMT of the paranasal sinuses with a fatal outcome. A 22 year old woman was admitted to hospital as a result of epistaxis. Computed tomography scan and magnetic resonance imaging showed an expansive process in the paranasal sinuses, extending into the nasal cavity, orbita, and endocranium. The tumour progressed despite several surgical procedures. Radiotherapy, corticosteroids, and chemotherapy were unsuccessful, and the patient died four years after diagnosis, as a result of extensive intracranial spread of the tumour. This is the first known case of an IMT of the head and neck region with a fatal outcome. It shows that the aggressive behaviour of IMTs is not limited to abdominal and mediastinal locations, and supports recent observations that at least a subset of IMTs represents true neoplasia rather than reactive myofibroblastic proliferation.

Wegener's granulomatosis in the upper respiratory tract.

Wegener's granulomatosis is a distinct clinico-pathological entity characterised by necrotising vasculitis of small arteries and veins in conjunction with the formation of granuloma in the upper and lower respiratory tracts, and glomerulonephritis. The vast majority of patients have antineutrophil cytoplasmic antibodies in the serum with a characteristic cytoplasmic pattern. However, in early phases of the disease only the upper respiratory tract may be affected, clinical and histological features may be nonspecific, and antineutrophil cytoplasmic antibodies not present. In this paper we present four patients with involvement of the upper respiratory tract suspicious for early Wegener's granulomatosis. We emphasise the significance of clinical, histological and serological parameters in the early detection of Wegener's granulomatosis.

Incidental prostatic carcinoma. A predictive role of neoangiogenesis and comparison with other prognostic factors.

Incidental prostatic carcinoma (ICP) has good prognosis related to low stage at diagnosis. Few rogressive cases demanding aggressive treatment need early identification. Neoangiogenesis proved its predictive role in prostatic carcinoma after radical prostatectomy. To reveal its value in ICP authors investigated specimens after transurethral resection of prostate (TURP). Retrospective study was performed on 68 ICP diagnosed in years 1985 1989. Microvessels highlighted by factor VIII were counted in a x200 microscope field (0,8012 mm 2 ) in most active areas of neovascularisation. Microvessel count was correlated with tumor differentiation degree, Gleason score, disease stage, and patients survival in at least 9 years after diagnosis. Higher maximal microvessel counts were associated with lower degree of tumor differentiation (p=0,005), Gleason score (p=0,001), and disease stage (0,003). No association with disease progression and patients survival was found. Mean microvessel counts showed less significant values when correlated with tumor differentiation degree (p=0,003) and Gleason score (p=0, 01), and no correlation with other variables. Microvessel density in TURP specimens of ICP retains its prognostic value already demonstrated in carcinoma of peripheral prostatic lobes. Maximal microvessel counts were prognostically more reliable than mean values.

Tumor neoangiogenesis in rebiopsied patients with prostatic carcinoma.

Tumor neoangiogenesis has proven its prognostic value in malignant tumors of different organs including prostatic adenocarcinoma. The aim of this retrospective study was to disclose the significance of neoangiogenesis in incidental prostatic carcinoma (ICP) after transurethral resection (TURP). The authors examined all patients having ICP diagnosed at the Institute of Pathology, Medical Faculty in Ljubljana during the 1985-1989 period, in whom rebiopsy was performed. Ten of 68 patients were examined to determine how microvessels correlate with the degree of tumor differentiation determined histopathologically, and with Gleason score, stage of disease, and survival time. Microvessels were highlighted by immunostaining endothelial cells for factor VIII-related antigen and counted in a x200 microscope field (0.8012 mm2) in the most active areas of neovascularization. Neoangiogenesis and tumor differentiation degree were then correlated between primary tumors and rebiopsies. Tumor differentiation degree was also correlated with the time of the disease progression. Microvessel counts (MVC) showed no association with the degree of tumor differentiation, Gleason score, disease stage, or patients' survival. The time elapsed to the disease progression was associated with less differentiated tumors (p = 0.004; 0.006). Microvessel counts were significantly higher in rebiopsies compared to initial tumors (p = 0.006), but no differences could be observed in the degree of differentiation. The results showed that the determination of microvessel density in rebiopsied patients had a better prognostic value than the degree of tumor differentiation. Nevertheless, the latter showed an association with the time of the disease progression. The number of patients included in the study was too low to confirm the association of MVC and degree of tumor differentiation in primary tumors.

Marginal vacuoles in fine-needle aspirates of follicular thyroid carcinoma.

Marginal vacuoles (MV) found in Giemsa-stained fine-needle aspirates of the thyroid gland have been observed in toxic and also in non-toxic goiters. The aim of our retrospective study was to disclose the incidence and diagnostic significance of MV in 46 smears from 43 patients with primary and/or metastatic follicular thyroid carcinoma (FTC). Typical MV, MV-like structures, or both were found in 14 of 36 specimens (39%) of the primary tumor and in four of seven specimens (57%) obtained from metastases of FTC. No association between the appearance of MV/MV-like structures and degree of tumor differentiation was demonstrated. On the other hand, MV or/and MV-like structures were more frequently (69%) documented in hyperthyroid patients (P < 0.05). Accordingly, our study demonstrated relatively frequent appearance of MV or MV-like structures in FTC independent of tumor differentiation. Their appearance, however, seems to be associated with hyperthyroidism.

Renal extraglomerular vascular immune deposits in IgA glomerulonephritis.

Kidney biopsies of 425 patients with IgA glomerulonephritis were studied to reveal the incidence, composition and possible clinical significance of extraglomerular vascular immune deposits. IgA deposits were detected in 20 cases, IgM in 28 (in 5 together with IgA), C3 in 317 and no vascular deposits in 60 cases. C3 and IgA deposits were granular, resembling mesangial deposits, while IgM deposits were lumpy, similar to IgM deposits in sclerotic and hyalinized glomeruli. The incidence of vascular lesions in patients with IgA (30%) and C3 deposits (24%) was not significantly higher as compared to those without vascular deposits (20%), but was significantly higher in patients with IgM deposits (68%, P < 0.00004). Only the presence of vascular IgM deposits correlated significantly with severe glomerulosclerosis, arterial hypertension and elevated serum creatinine levels (all P < 0.001). We conclude that neither C3 nor IgA deposits, in spite of their suggested immune complex nature, contribute significantly to the development of vascular lesions. Lumpy IgM deposits, probably the result of insudation of plasma proteins into the blood vessel walls, were associated with advanced vascular lesions and glomerulosclerosis and are probably a part of non-immune mediated progression of IgA glomerulonephritis.