The authors describe an umbilical anomaly marked by confluent erythematous and crusted plaques, spreading beyond the navel limits and histologically regarded as a choristia that is to say a displacement of intestinal tissue within the epidermis. The ultrastructural study investigated the relationship between intestinal cells and keratinocytes. The authors believe that behaviour analogies exist between ectopic intestinal cells and Paget's cells.

Choristoma↗

PubMedDate not supplied

Invasive node-negative breast carcinoma: multivariate analysis of the prognostic value of peritumoral vessel invasion compared with that of conventional clinico-pathologic features.

The prognostic value of the determination of peritumoral vessel invasion (PVI) in node-negative breast cancer (NNBC) patients is still controversial. This is mainly related to the subjective criteria of evaluation of this histologic finding using morphological methods only. In this study, to assess PVI by stricter criteria, we used both conventional morphological and immunocytochemical techniques, using antibodies specific to endothelial cells (i.e. factor VIII-related antigen and the CD-31 antibody). In a series of 233 evaluable NNBC, with a median follow-up of 5 years, we found that 11% of the tumors (25 out of 233) were PVI-positive. A weak association was observed only between PVI and tumor size (p = 0.076). In univariate analysis PVI significantly predicted relapse-free survival (p = 0.0009), but not overall survival (p = 0.1208). The odds of relapse and death for patients with PVI-positive carcinomas were 4.36 and 2.24 times higher than for those with PVI-negative tumors. As far as relapse-free survival is concerned, tumor size (p = 0.0012), histologic grading (p = 0.022), estrogen receptor (p = 0.016) and progesterone receptor expression (p = 0.017) also had a significant prognostic value. Only tumor size significantly predicted overall survival (p = 0.0038) in this series. For 5-year relapse-free survival both PVI (p = 0.014) and tumor size (p = 0.017) were significant and independent prognostic variables by multivariate analysis. Our results demonstrate that PVI and tumor size are important histological features to identify high-risk NNBC patients. Further studies are needed to compare the prognostic significance of PVI and tumor size with that of novel biological prognostic indicators of emerging importance in this neoplasia.

Adult↗

PubMedDate not supplied

[Angiodysplasia of the right colon].

Ascending colon angiodysplasia is a frequent cause of colorrhagia or chronic blood loss in old patients, but also possible under the age of 55. Angiodysplasia diagnosis is often underestimated. For a long time colorrhagia or lower intestinal bleeding were generally diagnosed like diverticular bleeding. This conclusion was the result of several conditions: the conservative management of distal gastrointestinal bleeding is in most cases successful; the double dye clysma was the first and the main diagnostic procedure for many years and the result was a not correct diagnosis of diverticular bleeding since large bowel diverticulosis is always present in the elderly. The authors report on three cases of low intestinal bleeding where the diagnosis of angiodysplasia in the first patient was performed by upper mesenteric artery arteriography, in the second by preoperative colonoscopy and after confirmed by the histology of the specimen and in the last one by colonoscopy performed in emergency and after intestinal irrigation. The first patients refused the operation; the second had right hemicolectomy and the third one had a spontaneous stop of bleeding. According to their clinical experience the authors suggest that colonoscopy performed in emergency or intraoperative is the first choice diagnostic procedure: it can detect the source of bleeding between right or left colon. Arteriography often shows vascular images characteristic for angiodysplasia or other vascular malformations but, in our experience, it may be absolutely not diagnostic. Colonoscopy performed in emergency during bleeding or per-operative is the best procedure in order to diagnose the source of bleeding. Emergency colonoscopy can distinguish if the blood is coming from the right or left colon and in our experience, colonoscopy during bleeding is always possible because blood has a cathartic effect. In case of emergency operation pre-operative colonoscopy can usually detect the source of bleeding. A double dye clysma, whether barium or hydrosoluble doesn't give a diagnostic support in low intestinal bleeding; on the contrary it can prevent a correct arteriographic and endoscopic evaluation. At last histopathological findings on the specimen are conclusive for the diagnosis.

Aged↗

PubMedDate not supplied

Tumor angiogenesis predicts clinical outcome of node-positive breast cancer patients treated with adjuvant hormone therapy or chemotherapy.

PURPOSE: Experimental studies suggest that angiogenesis is necessary for breast cancer progression and metastasis and that it may play a role in responsiveness to some chemotherapeutic agents and to tamoxifen. To investigate whether angiogenesis predicts the clinical outcome of patients with node-positive breast cancer, we determined intratumoral microvessel density in a series of patients treated with either adjuvant hormone therapy (n=84) or chemotherapy (n= 107). PATIENTS AND METHODS: We monitored 191 patients for a median of 62 months. Intratumoral microvessel density was measured using light microscopy, and microvessels were immunostained using the anti-CD31 antibody. Microvessels were carefully counted (per 200x field) in the most vascularized area of each tumor. The results of intratumoral microvessel density were analyzed by both univariate and multivariate statistical analysis and were correlated with clinical outcome. RESULTS: In univariate analysis, intratumoral microvessel density was significantly associated with relapse-free survival and overall survival, both in patients who received adjuvant hormone therapy and those who received chemotherapy. In the group treated with adjuvant hormone therapy, estrogen receptor status was also predictive for both relapse-free and overall survival. The number of involved nodes was predictive for overall survival. In patients treated with adjuvant chemotherapy, the number of involved nodes, tumor size, and progesterone receptor status were significantly predictive for relapse-free and overall survival. Multivariate analysis showed that intratumoral microvessel density was the strongest independent predictor of outcome in both treatment groups. CONCLUSIONS: Intratumoral microvessel density is an independent predictive indicator in node-positive breast cancer patients treated with either adjuvant chemotherapy or adjuvant hormone therapy. Assessment of tumor angiogenesis may therefore be useful in selection of those patients who are more likely to benefit from conventional adjuvant therapies (i.e., those with minimally vascularized tumors) from those with highly vascularized and more aggressive tumors, for whom novel forms of systemic therapy are advocated.

Adult↗