Sarcomatoid renal cell carcinoma with osteogenic differentiation and paraneoplastic hepatopathy in a dog, possibly related to human Stauffer's syndrome

Sarcomatoid renal cell carcinoma is an uncommon tumour in human beings, and osteogenic differentiation is a rare feature. This report describes such a case in a male dog aged 8 years. The tumour, which showed extensive osseous metaplasia and a few necrotic areas, protruded into the renal pelvis, disrupting the renal capsule. Light microscopical and immunohistochemical examination revealed the epithelial nature of the tumour. Abnormal liver biochemistry, mild hepatocyte degeneration and the absence of histological evidence of metastasis suggested a paraneoplastic hepatopathy.

[Bronchiolitis obliterans-organizing pneumonia (BOOP) containing asbestos bodies: clinico-pathological study of a case]

We describe a case of bronchiolitis obliterans-organizing pneumonia (BOOP) with asbestos bodies. A 65-year-old man, treated in the past for gastric lymphoma and with an history of asbestos exposure, presented with fever and two nodular opacities in the lower lobe of the left lung. Histologic examination revealed a BOOP pattern; in the inflammatory tissue some asbestos bodies were present. Patients exposed to asbestos may rarely present with localized inflammatory pulmonary lesions. In these cases, the possible etiopathogenetic role of asbestos needs further studies.

Dysplastic changes in gastric fundic gland polyps of patients with familial adenomatous polyposis

BACKGROUND

Fundic gland polyps are the most common gastric lesion in patients with familial adenomatous polyposis and are traditionally considered a condition with no malignancy potential. However, some reports have recently questioned this view.

AIMS

To prospectively evaluate their prevalence and the associated dysplastic/malignant changes in a series of affected patients.

PATIENTS AND METHODS

Thirty-seven affected patients were carefully investigated by upper endoscopy over a three-year period. Multiple (at least 10) complete excisions of any representative polyp of the body-fundus were performed and a thorough pathological search for microscopic adenomatous/dysplastic changes carried out.

RESULTS

Of 37 patients, 19 (51.3%) showed gastric fundic gland polyposis and 18 of them gave consent for polypectomies. Overall, 425 endoscopic polypectomies were performed, with a mean of 23.6 +/- 14.6 per patient. At pathology, all excised polyps of the body-fundus were found to be fundic glandular. Microscopic adenomatous changes within such polyps were identified in 8 (44.4%) patients. All the adenomatous foci revealed mild dysplasia with no case of severe atypia or carcinoma. Patients with microadenomas showed a significantly higher total number of gastric polyps compared with those without microadenomas (p < 0.03). No other differences between the two groups were observed. Two further patients presented microadenomas in apparently normal antral mucosa and one also showed a 6 mm antral adenoma with mild dysplasia. Finally, the search for Helicobacter pylori was always negative.

CONCLUSIONS

Patients with familial adenomatous polyposis and gastric fundic gland polyps have a high prevalence of microscopic adenomatous foci within such lesions; nevertheless, these foci seem not to be associated with signs of severe atypia or carcinoma. Moreover, microadenomas are ubiquitous throughout the stomach, as well as in the rest of the gut, and their natural history is still undefined. Thus, their malignancy potential remains uncertain. More extensive follow-up is warranted to better investigate the long-term biological behaviour of these lesions but, at present, our data do not support the need for a change in the usual intervals of upper endoscopy surveillance in familial polyposis patients with or without gastric fundic glands polyps.

Endoscopic snare papillectomy in patients with familial adenomatous polyposis and ampullary adenoma

The optimal treatment of adenomas of the papilla of Vater has still not been definitively established, and the endoscopic excision of such lesions has received little attention in the literature. We report here the cases of two patients with familial adenomatous polyposis, in whom ampullary adenomas measuring 8 and 20 mm, respectively, were treated using one-piece snare excision of the lesion together with the papilla (snare papillectomy), followed by temporary biliopancreatic drainage. Procedure-related complications were an oozing-type hemorrhage and a mild pancreatitis, easily controlled by conservative measures. During the 18-month follow-up, one patient had a small recurrence that was successfully retreated. Further endoscopic and biopsy controls were negative. Although limited, our experience and the data in the literature indicate that snare papillectomy is a viable alternative to surgery for benign ampullary adenomas. Excising both the lesion and the papilla offers good oncological debridement and, unlike laser or thermal ablation, allows a complete histological evaluation of the pathological tissue. However, snare papillectomy should always be associated with temporary biliopancreatic drainage before or after the procedure in order to prevent ductal obstruction and serious pancreatitis. This maneuver should therefore preferably be performed by experienced endoscopists trained in therapeutic endoscopic retrograde cholangiopancreatography and hemostatic techniques.

[Male diabetic mastopathy: description of a case]

A case of diabetic mastopathy in a male is described. The patient is a 44 year old man with an insulin-dependent diabetes of long duration, presenting with a poorly defined nodule in his left breast. The lesion was constituted by a dense fibrous tissue with epithelioid stromal cells and a perivascular nodular lymphoid infiltrate. The differential diagnosis and the literature on diabetic mastopathy are briefly reviewed, particularly regarding male patients. The present case indicates that diabetic mastopathy may arise in the male breast.

High prevalence of adenomas and microadenomas of the duodenal papilla and periampullary region in patients with familial adenomatous polyposis

BACKGROUND

Patients with familial adenomatous polyposis (FAP) are traditionally considered to be at high risk for duodenal-papillary and periampullary adenomas and cancer.

AIM

To evaluate prospectively the prevalence, histology and clinical significance of ampullary and periampullary macroscopic and microscopic lesions in our population of affected patients.

SETTING

Three gastroenterological departments of northern Italian hospitals.

PATIENT AND METHODS

Twenty-five affected patients were carefully investigated over a 24-month period by end-viewing and side-viewing upper panendoscopy. Biopsies were performed on representative macroscopic lesions and randomly on normal-appearing papillary and periampullary mucosa.

RESULTS

Seven patients had macroscopic adenomas of the duodenal papilla, three of the periampullary region and five at both sites (cumulative prevalence 40%). An additional six patients had macroadenomas in the rest of the duodenum (overall prevalence 64%). Microscopic adenomas were identified in nine and two patients in the papilla and periampullary region, respectively, and in three at both sites (overall prevalence 44%). Thus, a total of 17 (68%) patients presented macro- or microadenomas at these locations. The prevalence rose to 72%, when a further patient with macroadenomas in the rest of the duodenum only was included. Malignancy was not encountered and severe dysplasia was observed only in a macroadenoma of the second duodenal portion. A higher frequency of macroadenomas in the papilla and periampullary region was significantly correlated with the presence and number of such lesions in the rest of the duodenum (P = 0.04). No other significant association was detected either between micro- or macroadenomas at different sites or with the demographic, clinical and pathological features.

CONCLUSION

This study confirms that the duodenal papilla and periampullary region are sites with high prevalence of macro- and microscopic adenomas in patients with FAP. However, our data do not seem to support a higher frequency and malignancy potential of such lesions as compared to polyps in the rest of the duodenum. Nevertheless, these findings warrant a periodic, careful examination of the duodenum with either end-viewing or side-viewing endoscopy, the need for random biopsies of the papilla and periampullary region and the removal of any larger or rapidly growing lesions detected.

Triple therapy with azithromycin, omeprazole, and amoxicillin is highly effective in the eradication of Helicobacter pylori: a controlled trial versus omeprazole plus amoxicillin

BACKGROUND

Azithromycin is a new-generation, acid-stable macrolide antibiotic that achieves remarkably high concentrations in gastric tissue, persisting above the MIC90 for Helicobacter pylori over a 5-day period after a single 500-mg oral dose.

METHODS

We evaluated a new metronidazole-free triple therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g b.i.d. (both for 14 days) and azithromycin 500 mg mane (for the first 3 days only) (group I) versus double therapy with omeprazole 20 mg b.i.d. plus amoxicillin 1 g t.i.d., both for 14 days (group II). H. pylori status was determined by urease test and histology before and 6 wk after completion of therapy.

RESULTS

Ninety-two patients with peptic ulcer disease or nonulcer dyspepsia completed the study. H. pylori infection was eradicated in 44 (91.6%) of 48 patients randomized to receive triple therapy versus 26 (59.1%) of 44 who received double therapy (p < 0.001). Smoking, but not omeprazole pretreatment, proved to be a risk factor for treatment failure only in the double-therapy group (p = 0.05). All ulcers healed by the time of the 8-wk endoscopic control. Side effects, usually minor, were recorded in 12.5% and 9.1% of patients, respectively (NS), but therapy had to be discontinued in one patient in group I and in three in group II (NS).

CONCLUSIONS

Two-week triple therapy with omeprazole, amoxicillin, and (for the first 3 days) low-dose azithromycin is highly effective in eradicating H. pylori. This regimen is safe and well-tolerated, and we recommend that it be used as first-line treatment, as an alternative to less-effective omeprazole-amoxicillin double therapy. Moreover, azithromycin appears to be a new, promising antibiotic for future innovative anti-H. pylori combinations.

First observation of microadenomas in the ileal mucosa of patients with familial adenomatous polyposis and colectomies

BACKGROUND & AIMS

Little data are available on the type and prevalence of mucosal changes involved in the development of ileal adenomas in patients with familial adenomatous polyposis who have undergone colectomy. However, colonic metaplasia of the ileal epithelium is thought to be an important step in the development of such adenomas.

METHODS

Retrograde endoscopy and biopsy of the distal ileum were performed in 17 affected patients who underwent total colectomy or proctocolectomy 3-184.1 months (mean, 80.3 +/- 13.9 months) before the study.

RESULTS

Macroscopic ileal polyps were identified in 14 (82.4%) patients. All polyps were sessile and 1-5 mm in size. Histological analysis showed adenomas in 9 (52.9%) patients and lymphoid hyperplasia or inflammation in the others. In 1 patient, an area of colonic-type metaplasia of the ileal mucosa was found close to an adenoma. However, in 5 (29.4%) patients, random biopsy specimens of the normal-appearing mucosa showed foci of abnormal crypts in the absence of metaplasia, with histological appearance similar to the findings described in dysplastic aberrant crypt foci of the colon. Such lesions, previously observed only in colorectal mucosa and referred to as microadenomas or oligocryptal adenomas, are considered putative preneoplastic abnormalities.

CONCLUSIONS

Although the hypothesized sequence normal ileal mucosa leading to colonic-type metaplasia leading to adenoma cannot be excluded, our findings support the sequence normal ileal mucosa leading to microadenoma leading to gross adenoma and possibly cancer as the main histogenetic pathway, as already suggested for the large bowel.

Ectopic sebaceous glands in the esophagus: report of three new cases and review of the literature

Ectopic sebaceous glands in the esophagus are a very rare anomaly which have, until now, been described in only 14 living individuals. We describe here the macroscopic, pathological, and clinical features of three new endoscopically diagnosed cases of this benign condition. One of the three patients showed a very high number of lesions (more than 100) distributed throughout the esophagus. A review of the existing literature is presented and the possible pathogenetic mechanisms involved are discussed.

Visual "disappearing phenomenon" can reliably predict the nonadenomatous nature of rectal and rectosigmoid diminutive polyps at endoscopy

Previous studies have failed to differentiate adenomatous from nonadenomatous diminutive polyps according to their gross macroscopic features at endoscopy. We prospectively evaluated the prevalence, distribution, and predictive value of a recently described morphologic feature-the "disappearing phenomenon"-in diminutive polyps of the distal 20 cm of the large bowel by studying 218 polyps in 90 consecutive patients. Disappearance was graded as complete, incomplete, or absent. Overall, complete disappearance was noted in 93 (43.1%) polyps, with a significantly higher prevalence in the middle and lower rectum (p < .05) and among smaller, paler, and smooth-surface polyps (p < .001). Incomplete disappearance was detected in both nonadenomas (23.1%) and adenomas (15.8%), but, more importantly, complete disappearance occurred in none of the 19 observed adenomas compared with 93 of 199 nonadenomas. Multiple logistic regression analysis revealed that disappearance was the strongest predictor (p < .001) of nonadenomatous histology among considered morphologic criteria. When complete disappearance was used to predict histologic type of diminutive polyps, its sensitivity was 100% and its specificity was 46.7%. In conclusion, the disappearing phenomenon represents a reliable visual marker for identifying nonadenomatous rectal and rectosigmoidal diminutive polyps at endoscopy. Diminutive polyps that disappear completely upon insufflation are invariably nonadenomatous and should not require endoscopic biopsy or removal.

[Quality control of intraoperative diagnosis. Annual review of 1490 frozen sections]

A retrospective evaluation of the accuracy of frozen section diagnoses over 1-year period has been carried out. Of 20998 surgical pathology specimens accessioned during 1991, 1265 (6.0%) had intraoperative pathologic consultation; 1490 were the frozen section examinations effectively carried out, with an average of 1.2 frozen section diagnoses per case. Of all frozen sections performed, 4.6% were deferred; in the remaining cases, the concordance between frozen sections and the final histologic diagnoses was 97%. The reasons for diagnostic discordances were gross sampling error (51.2%), misinterpretation (44.2%), microscopic sampling (9.3%), technical problems in sectioning (2.3%). We believe that a similar continuous monitoring should be performed in every pathology department, to recognize the reasons of errors and, if possible, to reduce them.

Valore Predittivo del Mapping Prostatico Nella Valutazione Preoperatoria Del Volume Della Neoplasia Prostatica: Studio Ecografico ed Anatomopatologico su 25 Pazienti Sottoposti a Prostatectomia Radicale Retropubica

Quantitative tumour volume is reported to be the single most important morphologic predictor for lymph node metastases and distant spread in the individual patient with prostatic cancer. 25 patients with histologically proved prostatic cancer underwent Prostatic Mapping before Radical Retropubic Prostatectomy. Surgical specimens were processed and prostatic cancer volume was calculated according to abbreviated standard procedure that avoids the serial blocking of prostatectomy specimens required by standard techniques. Our study demonstrated a strong correlation between Prostatic Mapping categories and prostatic cancer volumes. This ability of Prostatic Mapping to estimate preoperatively the tumour volume may be a useful clinical tool to help guide surgical therapy and assess prognosis.

Proliferative lesions of the breast lobules. A morphometric analysis

A morphometric study was carried out on proliferative lesions of the breast lobules, including cases of atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS) and infiltrating lobular carcinoma (ILC) with axillary metastases (META). Seven nuclear parameters were assessed, such as perimeter, area, shape factor, diameter of circle of equivalent area, longest axis, shortest axis and axes ratio. In comparison with nuclei of normal lobules, a statistically significant increase in the mean values of 5 nuclear parameters was observed in all pathologic lesions examined, whereas shape factor and axes ratio exhibited no significant difference. Nuclear area was found to be the most valuable parameter. No difference was observed between nuclear estimates of ALH and LCIS. Mean nuclear values were higher in ILC cases than in in-situ lesions, but no difference was detected between ILC and axillary metastases.

Immunohistochemical markers of sweat gland tumors

Using immunoperoxidase methods, normal sweat glands, 44 benign and 4 malignant sweat gland tumors were tested for the presence of carcinoembryonic antigen (CEA), pregnancy-specific-B1-glycoprotein (SP1) and actin (ACT). CEA and SP1 stained the secretory and duct-lining cells of normal eccrine glands. Among benign tumors, 74% were positive for CEA and 44% for SP1. The staining reaction was found mainly in luminal secretions and surrounding cells. Staining by SP1 was reduced, but not suppressed, after absorption with the purified antigen. ACT was found in myoepithelial cells of the secretory tract of normal glands and in basal cells of all cases of hidradenoma papilliferum. Only 3 sweat gland carcinomas reacted for CEA. In a malignant chondroid syringoma, no ACT-positive cells were seen in the myxochondroid stroma. The potential value of CEA, SP1 and ACT in the diagnosis of sweat gland tumors is discussed.

Early (stage A) prostatic cancer. VI. A critical look at the follow-up

The 4 year follow-up of an original series of 100 patients treated by subtotal prostatectomy and analysed on histopathological grounds is presented. 87 out of 100 were traced and were in the following groups: 37/45 A1, 27/29 A2, 10/12 A3, 13/14 benign prostatic hyperplasia. No therapy was performed. All three patients who died of prostatic carcinoma fitted into substage A3, all three patients living with metastases fitted into A1. The progression observed is significant when related to the brief interval of time, the size of the prostatic microcarcinoma and the histological grade (well differentiated tubular carcinomas in 5 out of 6 cases). Prostatectomy with capsulectomy is strongly recommended in order to prevent progression.