A case of femur-fibular-ulna complex with peculiar metaphyseal changes

Femur-fibular-ulna (FFU) complex is an unusual, sporadically occurring limb malformation disorder, characterized by a highly variable combination of congenital defects of the femur, the fibula and/or the ulna, which tend to be associated. We report the case of a fetus with FFU complex and additional striking metaphyseal anomalies of the lower limbs and an abnormal chondrocyte organization pattern. To our knowledge this is the first reported case of histologic metaphyseal alterations in association with the FFU complex.

Radiological-pathological comparison in a case of conjoined gnatho-thoracopagus twins

BACKGROUND

Conjoined twins may present an extremely wide range of complex congenital malformations. Because of the increasing number of attempts to separate them surgically, profound knowledge is needed of this abnormality spectrum.

CASE

Ultrasonographic, radiological (X-ray, computed tomography and magnetic resonance imaging) and pathological findings of gnatho-thoracopagus conjoined twins at 18 weeks of gestation are reported, focusing on clinical topographic correlations.

CONCLUSIONS

High-resolution imaging techniques may provide useful information for surgery or autopsy planning of cases with complex congenital malformations.

Early detection by magnetic resonance imaging of fetal cerebral damage in a fetus with hydrops and cytomegalovirus infection

We discuss the use of magnetic resonance imaging (MRI) to reveal early fetal neurological involvement of cytomegalovirus (CMV) infection. A woman presented at 21 weeks of pregnancy with active CMV infection. Cerebral ultrasound examination had been normal. An MRI scan revealed a thickened germinal matrix, which was histologically confirmed, associated with underdevelopment of the gyri. Brain MRI proved particularly useful in identifying the findings not disclosed by routine ultrasound during pregnancy and subsequently confirmed at histology.

Sudden death due to aortic rupture in acromegaly

Acromegaly, when left untreated, is associated with premature mortality which is chiefly related to cardiovascular complications. We report on a 50-year-old acromegalic woman, resistant to therapy, who died suddenly because of thoracic aortic rupture and massive bleeding into the left pleural space. The postmortem examination disclosed, nearby the point of rupture, a pulmonary abscess as well as extensive intrinsic alteration of arteries originating from the aortic arch and aorta itself, which featured microscopic cystic medial necrosis. We discussed how these aspects could be related to long-term exposition to growth hormone excess. In particular, this case gives further evidence of vascular system frailty in acromegaly.

An unusual case of malignant pilocytic astrocytoma occurring in the eye

Pilocytic astrocytoma is a central nervous system neoplasia that arises during pediatric age. Only few cases have been documented in patients older than 50 years old. It is a low-grade lesion that can rarely undergo malignant changes presenting the histologic features of a high-grade glioma. We report a case of a pilocytic astrocytoma arising in the eyeball of a 53-year-old man affected by glaucoma that underwent malignant evolution.

Prognostic value of protein p53 and ki-67 in invasive vulvar squamous cell carcinoma

The aim of this research was to detect new valid prognostic indicators that allow us to choose the best therapy and follow-up for patients with a poor prognosis. One hundred and twenty-nine patients with invasive squamous carcinoma of the vulva treated at the Gynecology Clinic of the University of Padua between January 1, 1975 and December 31, 1999 have been evaluated: Protein p53 and ki-67 were studied by immunohistochemical investigations and their prognostic significance was evaluated. The relation with the classic clinico-pathological prognostic factors was also studied. The results showed a close association between tissue overexpression of the two proteins and clinico-pathological characteristics of the aggressivity of the neoplasm. Moreover, the group of positive p53 patients with a diffuse distribution pattern of ki-67 resulted in having a somewhat shorter survival with respect to the groups with negative p53 and/or a focal pattern. Such negative prognostic significance was confirmed by the results of the multivariate analysis performed with the Cox model which shows that patients with p53 positive values and a diffuse pattern have a higher relative risk of death compared to patients with p53 negative values and focal pattern (p=0.0001). The statistical significance of the prognostic value of the association of p53 and ki-67 thus seems to give these two factors greater weight with respect to the others we investigated.

Prognostic value of bcl-2, p53 and Ki-67 in invasive squamous carcinoma of the uterine cervix

The aim of this study was to evaluate the immunohistochemical expression of the markers bcl-2, p53 and Ki67 and their relation to the classical clinical-pathological prognostic factors in invasive squamous cellular carcinoma of the cervix. Since bcl-2 and p53 are implicated in the regulation of programmed cell death, very probably they play a role in carcinogenesis and consequently become prognostic factors.

cDNA cloning and characterization of PD1: a novel human testicular protein with different expressions in various testiculopathies

A novel human cDNA sequence has been isolated from human testis cDNA library. This sequence, named PD1, reveals an open reading frame encoding a protein of 520 amino acids. A partial sequence similarity has been found with the RBM gene involved in the regulation of human spermatogenesis. Northern blot analysis for PD1 mRNA from several human tissues demonstrated two distinct transcripts of 2.7 (more abundant) and 4.0 kb and revealed that PD1 is expressed in testis and to a lesser extent also in spleen, thymus, and prostate. Immunohistochemical analysis of human testis showed that this protein is detected in the cytoplasm of Sertoli cells. Antibodies against a rhPD1 fragment were used for Western blot analysis, which confirmed the presence of a 60-kDa molecule in crude extract of human testicular cells obtained from fine-needle aspiration and showed different patterns in various testiculopathies, suggesting a role for such gene in human spermatogenesis.

Aggressive angiomyxoma of the vulva: expression of estroprogestinic receptors and follow-up

PURPOSE OF INVESTIGATION

To analyze aggressive angiomyxoma hormone-dependency.

METHOD

Estroprogestinic receptor expression was studied by immunohistochemistry in 5 patients with aggressive angiomyxoma of the vulva.

RESULTS

The immunohistochemical results confirm the positivity of angiomyxoma for estrogen and progesterone receptors.

CONCLUSIONS

We hypothesized that the concomitant factor favoring neoplastic growth is a different genetic substrate specific in the female sex. Analysis of the data regarding the distribution of angiomyxomas in different age groups has strengthened this hypothesis suggesting that this tumor is correlated with complete maturity, in all probability hormonal. However it cannot be excluded that the tumor begins to develop at an early age, but since it has a slow growth rate, the phenomenon is delayed and is related to hormonal stimulation.

Polytetrafluoroethylene giant granuloma and adenopathy: long-term complications following subureteral polytetrafluoroethylene injection for the treatment of vesicoureteral reflux in children

PURPOSE

The use of polytetrafluoroethylene as bulking agent for the endoscopic treatment of vesicoureteral reflux in children has raised many concerns about the implant histocompatibility and the risk of migration of polytetrafluoroethylene particles. We report on 3 cases of long-term complications following subureteral polytetrafluoroethylene injection (STING) and an extensive review of the literature is presented.

MATERIALS AND METHODS

Between January 1993 and December 1995, 3 children (2 males, 1 female; 4, 7 and 6 years old), previously submitted to STING, underwent open surgery for recurrent vesicoureteral reflux.

RESULTS

In 1 case a hard nodular mass, strictly adherent to the ureteral wall, was a foreign body giant granuloma. All patients demonstrated a heavy multinucleated foreign body reaction around polytetrafluoroethylene particles in the pelvic nodes.

CONCLUSIONS

Many experimental studies and some clinical observations have demonstrated that polytetrafluoroethylene particles elicit a foreign body granulomatous reaction and have the tendency to migrate. Until the long-term effects of their presence are well known, STING should be carefully evaluated in children and young patients.

[Solitary fibrous tumor of the pericardium]

A 60-year-old man with a large pericardial effusion was found to have a large intrapericardial mass located anteriorly to the right ventricle and firmly attached to the ascending aorta and pulmonary trunk. Histologically the mass, which was completely excised together with its large base of implant, was found to be a Solitary Fibrous Tumor. After a 46-months follow-up the patient is free from symptoms and signs of recurrence. Solitary Fibrous Tumor is considered a benign tumor and its excision curative, however aggressive variants and metastasis have been reported. Patternless architecture, fibrous collagenous stroma, exclusive vimentin positivity and the lack of ultrastructural mesothelial markers are important tools for the diagnosis. Because of the extreme rarity of intrapericardial location and lack of information on long-term behaviour of this tumor, close non-invasive follow-up is necessary.

Primary malignant melanoma of the female urethra: a case report

A case of primary malignant melanoma of the female urethra is reported. Physical examination and visceral studies confirmed the primary character of the tumour and histologic examination proved it to be nodular malignant melanoma. Less than 100 cases have been previously reported. The role of immunohistochemical stains to substantiate the diagnosis is stressed. Therapy and prognosis are briefly discussed.

Flow Cytometric Evaluation on Deparaffinized Material in Prostatic Carcinoma

DNA nuclear ploidy determined by flow cytometry was evaluated from prostatic tissue in 64 patients with prostatic cancer who had undergone radical prostatectomy. DNA ploidy was compared to tumour stage, tumour grading (Gleason score), PSA. DNA ploidy pattern was diploid in 46% and aneuploid in 54% of the tumours. Tumours pathologically staged B acc. to AUS were aneuploid in 25%, those staged C in 59% and those staged D in 66.6%. Aneuploidy was found in 36% of the tumours with Gleason score between 2 and 4, in 63% between 5 and 7 and in 45% between 8 and 10. Mean preoperative seric PSA was 34.3 ng/ml in diploid tumours and 39.8 ng/ml in aneuploid neoplasms. Our results suggest no relationship between tumour stage, grade and preoperative PSA.

Primary rhabdomyosarcoma of the diaphragm. Report of a case presenting with hemothorax

A rare case of embryonal rhabdomyosarcoma of the diaphragm occurring in an adult male and presenting with hemothorax is reported. The unusual clinical features of this patient underline the need for an accurate preoperative evaluation. The surgical procedure consisted of left thoracotomy with resection of the neoplasm, including a portion of the diaphragm muscle, and then reconstruction. One month after discharge chemo- and radiotherapy were carried out. The immunohistochemical study proved to be very helpful for the pathological diagnosis. A three years follow-up with patient alive and disease-free confirms that a multimodal approach may prove effective in the long term.

Sonography of abnormal lymph nodes in vitro: correlation of sonographic and histologic findings

The sonographic evaluation of lymph nodes is based primarily on evaluation of their shape and size. Recently, however, the availability of high-frequency transducers has made consideration of internal structure possible. An important objective is to determine whether node enlargement is due to inflammatory or neoplastic processes. To determine the accuracy of sonography for this purpose, we obtained in vitro sonograms of 53 enlarged lymph nodes excised from 41 patients during surgery for neoplastic or nonneoplastic disease. The sonograms were obtained with 7.5- and 10-MHz transducers. They were interpreted by a radiologist who was unaware of the clinical diagnosis. The nodes were subsequently processed for anatomohistologic study; findings were compared side by side. In 26 of the 53 nodes, sonograms showed an identifiable central echogenic line, which on histologic specimen corresponded to the internal part of the medulla where the lymphatic sinuses converge. All these nodes were benign. Two other nodes had an echogenic internal structure not resembling the normal hilum; in one case this was caused by metastatic disease and in the other by fibrosis. Sonograms of the remaining 25 nodes showed no detectable hilar structure; 21 were involved by a tumor and four had diffuse fatty replacement. Our results suggest that the sonographic finding of a central echogenic line is a valid criterion of benignity. Absence of this finding may be due to factors other than neoplastic disease, such as fatty replacement.