Biomedical subjects
Publications and source records attributed to D Reale.
Authors report a case of embryonal rhabdomyosarcoma of the breast occurring in a 16-year-old girl. To date, 26 cases have been described in the literature of which only 4 in girls younger than 16 years. Histological features, immunohistochemical findings and differential diagnosis are discussed.
Authors report two cases of pancreatic metastasis from renal clear cell carcinoma, discovered in a 62 years-old-man and in a 73 years-old woman, respectively 17 and 11 years after undergoing curative nephrectomy for primary tumor. Immunological forces and slow doubling times of tumor may explain this type of late recurrence, whereas, the endocrine status is lacking in importance. The risk of a recurrence of tumour ten years or later after nephrectomy suggests a lifelong follow-up of patients with an history of renal cell carcinoma.
We studied microscopic sections of 24 cases of intestinal infarction looking for contraction bands (CB) in the muscularis propria of the bowel wall. Controls were 11 surgical and 11 autopsy cases from patients who did not suffer any form of ischaemic disease. The difference of CB frequency was significant (P less than 0.001) in infarction versus the surgical control group. Moreover, within the study group the CB frequency was also related to the severity of the ischaemic lesion (P less than 0.01). With immunostaining, CB were not reactive with antibodies against vimentin, desmin, actin or myosin. We propose that CB genesis in intestinal smooth muscle is related to hypoxia, possibly through altered homeostasis of calcium and catecholamine metabolism.
Thirty-four patients, with a history of persistent abnormal uterine bleeding and dilatation and curettage or suction curettage performed within the previous year, were evaluated by office hysteroscopy and biopsy. For 16 patients (47%) the hysteroscopic diagnosis was in agreement with the curettage. Hysteroscopy revealed more information in 18 patients (53%): 8 had polyps, 6 had submucous or pedunculated myoma, 2 had endometrial neoplasia, 1 had myoma and polyp, 2 had endometrial neoplasia and 1 had synechia. Moreover in 3 patients with diagnosis of suspected myoma by curettage, hysteroscopy revealed a normal cavity. The high incidence of missed diagnosis of pathologic conditions by "blind" curettage supports the opinion that diagnostic hysteroscopy is the method of choice in the evaluation of abnormal uterine bleeding.
The use of outpatient diagnostic hysteroscopy is discussed with reference to a series of 425 women. The test was performed in an outpatient setting with no form of analgesia, anesthesia or premedication in 385 patients (90.6%); the degree of acceptability was very low (intolerable) in 5.5%, supportable in 15.8% and excellent in 78.7% of patients. Fourty-two per cent of patients were aged between 45 and 54 years old, and the mean age was 47.5 years with a range between 18 and 83 years. The indication for the test was pre- or postmenopausal anomalous uterine bleeding in 74% of patients. Hysteroscopic diagnosis was normal in 56% of cases; endometrial polyps were diagnosed in 11.4% of patients; myomas in 11%; low-risk hyperplasia in 9.9% and malignant tumours in 3.6%. The correlation between hysteroscopic diagnosis and histological tests was above 95% in cases of malignant tumours, atrophy and functional endometrium, whereas it was 67% in cases of low-risk hyperplasia. No accidents or complications related to hysteroscopy were reported.
Colposcopy and biopsy were performed in 97 patients whose referral smears showed mild dysplasia (CIN 1). Of 97 women, 40 (41.2%) had a biopsy or a colposcopic examination alone considered normal, 36 (37.1%) had CIN 1 or HPV changes, 12 (12.4%) had CIN 2 and 9 (9.3%) had CIN 3. No invasive cancer was detected. This data suggest that, if colposcopy resources are available, repeat smear alone is inadequate to follow women who have a mild dysplasia smear.
We investigated 110 cases, selected at random out of the total of 1876 autopsies performed in the Institute of Pathological Anatomy and Histology at the University of Ferrara-Arcispedale Santa Anna on patients who had died at the hospital during 1983-87. Clinical data were taken from 'necropsy request forms' filled in by clinicians and from medical records. We then evaluated the extent of agreement and disagreement, expressed as underdiagnosis (false-negative) and overdiagnosis (false-positive), between the clinical and pathological records with regard to primary disease and to cause of death. Agreement between the diagnoses was 81% for primary disease and 58% for cause of death. The diagnoses of neoplastic, cerebrovascular and cardiovascular diseases showed the closest agreement. Among the neoplasms, those of the liver, gall-bladder, pancreas, retroperitoneal space and prostate were most often overlooked in clinical diagnoses. We had conflicting results for cancer of the lung and of the colon-rectum, for which there was a high level of agreement, but also a large number of false-positive cases and cases in which they were found by chance at autopsy. For cerebrovascular diseases, false-negative and false-positive diagnoses were seen most often for cause of death. With regard to cardiovascular diseases, a relatively uniform distribution was found for myocardial infarction among the three categories, and a high rate of agreement was found for pulmonary embolism. Of all diseases, bronchopneumonia was associated with the highest percentage of false-negative diagnoses for cause of death. Our data on digestive diseases show the strongest agreement on diagnosis of primary disease in relation to cirrhosis of the liver; a high rate of agreement on cause of death was confirmed for alimentary bleeding. Active tuberculosis was detected only at autopsy. We conclude that autopsy is a valid tool for investigation, despite the availability of sophisticated diagnostic techniques.
Benign schwannoma in the parotid gland. Authors report a case of a benign schwannoma of the parotid gland, whose correct diagnosis had been suggested after the FNAB. They check the literature for similar cases since the sixties and discuss the differential diagnoses in the cytologic specimens obtained by FNAB.
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Authors report a case of alveolar variant of infiltrating lobular carcinoma of the breast with stromal osteoclast-like giant cells. Immunohistochemically the carcinoma cells were reactive for EMA and Cytokeratins; osteoclast-like giant cells (OCL-GC) were negative. OCL-GC and histiocytoid mononuclear cells with nuclei similar to those within the OCL-GC present in this case, were strongly immunoreactive with KP-1, a recently developed monoclonal antibody directed against cells of mononuclear phagocytic lineage in routinely processed tissue section and showed immunoreactivity to vimentin. These findings of our case provide evidence against a carcinoma cells derivation and support a monocytic/histiocytic origin for the OCL-GC.