Prominent Plasmacytic Differentiation in the Recurrence of a Parotid Immunocytoma. A Morphologic and Immunohistochemical Study

We report and discuss a case consisting of 2 lesions that developed at different times in the same parotid gland. Although the first lesion showed morphologic features similar to those of the benign lymphoepithelial lesion, a monotoypic IgM/K pattern was also revealed by the immunoperoxidase method in its lymphoid infiltrates. Thus, on cytologic grounds, the first lesion was classified as lymphoplasmacytic immunocytoma (according to Kiel criteria). In the second lesion, which recurred 3 years later, the prominent feature was a marked predominance of plasma cells with the same monoclonal IgM/K as the preceding lymphoma. These findings suggests that a B-lymphomatous cell monoclone may undergo morphologic maturation along the lineage of its competence. Secondly, they indicate that every case of benign lymphoepithelial lesion of the salivary glands should undergo thorough immunologic evaluation to exclude the possibility of signs of precocious lymphomatous transformation.

The biological reaction to polyethylene wear debris can be related with oxidation of the UHMWPE cups

BACKGROUND

Oxidised UHMWPE due to gamma irradiation in air has a greater susceptibility to wear than non-oxidised UHMWPE (ethylene oxide, EtO).

AIM

To evaluate, the biological reaction of loose implants with oxidised and non-oxidised PE components.

MATERIALS AND METHODS

Ten loose PE cups sterilised by EtO (group 1) and 13 sterilised by gamma irradiation in air (group 2) were studied. PE wear and oxidation were related to biological reaction.

RESULTS

Group 1: PE cups had low wear score and no oxidation. In the oldest implants, a few PE particles and macrophages were observed in the interface membrane. Group 2: PE inserts had medium-to-high PE wear score and variable oxidation. In the interface membrane, the number and total area of PE particles were high and variable; giant cells were more numerous than macrophages.

CONCLUSION

Junctional tissues around loose oxidised PE components contain more PE debris and giant cells than membranes around PE components that are not oxidised.

Ileal perforation due to ileocecal endometriosis: a case with an unusual clinical and pathological presentation

A 34-year-old woman, was admitted to the emergency room of our hospital with a history of symptoms of abdominal pain dating back several years and transitorily related to the menstrual cycle. These had worsened in the days prior to admission. Radiological and clinical examinations detected no signs of peritonitis. During exploratory operative laparoscopy, opted for because of persistence and intensification of the abdominal pain, diffuse peritonitis was found due to an ileal perforation immediately upstream of an ileocaecal mass causing a precaecal stenosis. Laparoscopy enabled us to diagnose the preoperatively undetected complication, to perform a through peritoneal lavage and, following minimal conversion by laparotomy, to perform ileocaecal resection, thereby limiting the severity of the surgical trauma. The definitive pathological diagnosis was ileocaecal endometriosis with signs of transmural fistulisation and the presence of endometrial glandular structures in one of the lymph nodes around the lesion. Perforation is a rare complication on those segments of the intestine most often affected by endometriosis, such as the colon and appendix. However, it is even more unusual when it affects the ileum and no other cases have been reported in the literature. Its genesis is attributed to late diagnosis. The pathological findings highlight the particular characteristics of this case. We would stress the pre-, intra- and postoperative diagnostic difficulties encountered and the importance of a thorough anamnestic assessment when making differential diagnoses in women of child-bearing age with abdominal or pelvic pain and perimenstrual symptoms.

[Squamous carcinoma of the gallbladder. Anatomo-clinical study of a case with reference to oncogene expression]

Squamous cell carcinoma of the gallbladder is a rare tumor with an ill-defined clinical course. We report a case of pure squamous carcinoma of the gallbladder with a rapidly fatal outcome. The tumor cells were positive for oncogenes P53, c-Erb B2 and Ki 67. This feature has no comparison with other reported cases of squamous carcinoma of the gallbladder but it is in accordance with oncogene expression in adenocarcinomas.

Poorly differentiated thyroid carcinomas with primordial cell component. A group of aggressive lesions sharing insular, trabecular, and solid patterns

Poorly differentiated carcinomas of the thyroid share insular, trabecular, and solid histological patterns that are different from those of papillary, follicular, medullary, and anaplastic varieties. We have collected 63 cases of poorly differentiated thyroid carcinomas. Thirty-one tumors (Group A) corresponded to the so-called insular carcinomas, and 32 tumors (Group B) had predominant trabecular and solid or focally follicular patterns in the presence of a minor insular component. The cells characterizing these lesions were relatively small and globoid, with uniform nuclei and intracytoplasmic deposits of thyroglobulin. They were in every respect similar to primordial cells present in the early stages of fetal thyroid development. None of the tumors proved fatal within 6 months, and most responded to radioiodine therapy. Although no differences in survival between the two groups were found, a significantly (p < 0.01) higher percentage of recurrences or distant metastases was observed with Group A tumors. The term primordial cell carcinoma appears appropriate for this type of tumor, which displays characteristic histocytological features and production of thyroglobulin. Clinically, these tumors are aggressive but generally show a slow course and good response to radioiodine therapy.

[Comparative morphological study of the structure of the normal and arteriosclerotic internal mammary, coronary, and renal artery wall]

Morphological comparative study of the normal anatomy of the internal mammary artery, coronary artery and renal artery, and their atherosclerotic alterations. We report in this paper the comparative results of a morphological and morphometrical study of the normal anatomy of the Left Coronary Artery (interventricular descending branch) (LCA), Internal Mammary Artery (IMA) and Renal Artery (RA) and their atherosclerotic alterations in 27 unselected people of both sexes aging from 19 to 76 years (average 59 +/- 14.3). Sections from three different segments of each vessel were examined by measuring the thickness of the intima and media calculated at the maximum intimal thickening. The lumen was also measured at the level of its highest pathological reduction; the same measurements were carried out on sections free from atherosclerotic damage. Then the intima to media ratio was assumed as major indicator of atherosclerosis involvement according to the literature. All these parameters were statistically analysed. With these procedures we found that LCA displayed more severely atherosclerotic changes than IMA. The degree of damage in RA fell in between when compared to the other arteries. The intima to media ratio average was 0.061 mm. (+/- 0.084) in I.M.A.; 0.882 mm. (+/- 0.753) in L.C.A. and 0.272 (+/- 0.315) in RA with statistically significant differences between IMA and LCA (p less than 0.001) and between IMA and RA (p less than 0.001). In the lesion free sections intima to media ratios were 0.178 (+/- 0.90) in LCA, 0.053 (+/- 0.28) in IMA and 0.082 (+/- 0.127) in RA. The difference was statistically significative between LCA and IMA, but not between RA and IMA.(ABSTRACT TRUNCATED AT 250 WORDS)

[Actinic lesions of the small intestine requiring surgery. Case reports]

Radiation enteropathy is a disease that seldom requires surgical treatment, in the chronic variety. We report the findings of four cases we operated in an attempt to identify the weak points of surgery involving a high percentage and morbidity of mortality. NPT (total parenteral nutrition) can favour a positive evolution with total rest of the bowel and with reinstatement of normal nutrition.

[Incidence of atherosclerosis of the internal mammary artery compared with the coronary artery. A study of 22 non-selected autopsy cases]

In the present work the examination and comparison of the degree of atherosclerotic involvement of the left coronary artery (CDA) and internal mammary artery (AMI) was performed on 22 unselected subjects at necroscopy examination. The maximum age was 77 and the minimal was 25 (average 62.59 +/- 2.47); 13 were male and 9 female. We macroscopically and microscopically examined three sections obtained from three different segments for each vessel. First we macroscopically evaluated the degree of narrowing of the lumen giving a score (+ to +). (Tab. II). Then the sections, 6 micron thick, stained with Haematoxylin-eosine, Alcian blue, PAS and Van Gieson methods were accurately examined at microscope with a graduated eyepiece. The lumen, the intima and the media were measured at the level of maximum thickness of the intima. Then the thickness of intima and the intima to media ratio, accordingly to the literature, were assumed as major indicators of atherosclerosis involvement. The intima to media ratio average was 5.05 (+/- 5.81) in the CDA vs. 0.44 (+/- 0.29) in the AMI (p less than 0.001). The intima in the CDA was 0.86 mm (+/- 0.76) thick (average) vs. 0.09 mm (+/- 0.07) in the AMI (p less than 0.001). These results show a great difference in atherosclerosis involvement which results to be ten times greater in CDA than in AMI in non selected people. Almost the same result is obtained by the measurement of the intima. On the contrary no detectable difference was found between the media of the two vessels.

Immunologic cell markers of peripheral blood and lymph node lymphocytes in chronic lymphocytic leukemia

The immunologic phenotype of the lymphocytes of 100 patients with chronic lymphocytic leukaemia (CLL) was investigated. Peripheral blood lymphocytes (PBL) were examined in all cases; in 46 patients with lymphadenopathy, a lymph node was biopsied and the histologic and immunologic patterns were assessed: 24 had a lymphocytic-lymphoplasmocytoid histology and 22 the follicular variant of lymphocytic lymphoma (mantle zone lymphoma, MZL). For comparison, lymph node suspensions from 19 patients with non-leukemic centrocytic lymphoma (CCL) were also studied. Significant differences in the PBL immunologic features were found between stage O and stage I patients. The phenotype of the lymphocytes of patients with lymphocytic histology was similar to that of stage 0 CLL patients, whereas major differences were found between these patients and those with mantle zone histology. This enables these patients to be recognized easily on immunologic grounds.

Acid hydrolases in B-chronic lymphocytic leukemia (B-CLL): a comparison with normal peripheral B lymphocytes and normal B-cell subset with the phenotype of B-leukaemic cells

The acid phosphatase (AP), beta-glucuronidase (BG), and alpha-naphthyl-acetate esterase (ANAE) distribution and the morphology of stage 0 B-CLL lymphocytes were studied. The results were compared with the same hydrolase equipment and morphology of normal B-cell populations showing the B-CLL-like phenotype, and thus regardable as the possible counterpart of leukaemic cells. The functional and structural characters of the former were strikingly different from those of the latter. In fact the normal B-cell population with B-CLL-like phenotype showed an homogeneous enzyme pattern with predominant ANAE and a strictly lymphocytic cell morphology. In contrast, the leukaemic cells showed various and unrelated morphological and cytochemical features, thus forming apparent subgroups of B-CLL. The development of an irregular "switch on" mechanism in the blocked malignant cell clone, may account for these functional and structural maturation discrepancies. Moreover, the fact that in the leukaemic cells ANAE activity could be demonstrated only after the appearance of the other hydrolases, makes it a marker of functionally differentiated B lymphocytes.

Immunohistochemical and enzyme histochemical contributions to the problem concerning the role of the thymus in the pathogenesis of myasthenia gravis

Normal fetal and postnatal thymuses, as well as thymuses from patients with myasthenia gravis (MG), were investigated by immunohistochemical and enzyme histochemical techniques and their morphology reviewed. Intrathymic B-cells, detected by ATPase activity, were found to be markedly increased in number in MG thymuses. They were scattered in the medulla and accumulated around the junctional and medullary vessels and Hassall's corpuscles (HCs). Large epithelial cells, singly or within HCs, were found to be unevenly distributed in the medulla of all the thymuses examined. The striated muscle-like nature of some of these cells was revealed by the presence of myoglobin in their cytoplasm. In myasthenics these cells and small developing HCs characteristically surrounded lymph follicles and were in direct contact with the expanded cap of the follicle mantle, without interposition of reticulin fibres. The close association of immune reactive foci (lymphoid follicles, junctional and medullary vessels, and HCs) with structures involved in autoimmune responses in the thymus (muscle-like and true myoid cells, HCs) strongly suggests that the autoimmune reactions against AChR (acetylcholine receptor) and other muscular components, which constitute the basic defects in myasthenia gravis, may begin in the thymus.

Histochemical study on human germinal centre, mantle-zone and extra-follicular area lymphoid cell subpopulations. Immunological and cytochemical correlations with lymphomatous cells, peripheral normal and leukemic lymphocytes

Tissue sections of lymph nodes, appendices and tonsils, together with smears of immunologically separated peripheral lymphoid cells from a B-CLL and lymphomatous cells from an immunocytoma were submitted to combined enzyme cytochemical investigations with acid alpha-naphthyl acetate esterase (ANAE), beta-glucuronidase (B-G), acid phosphatase (AcPh), adenosine triphosphatase (ATPase), a,d 5'nucleotidase (5'N). T-cells were Acph+, ATPase- and 5'N-. The vast majority of T- and B-cells displayed ANAE and B-G activities with two distinct staining patterns (T-like and B-like pattern). A high proportion of lymphoid cells in the germinal centre (G.C.) and the vast majority of lymphoid cells in the mantle-zone (M.Z.) were shown to belong to B-cell system because of the expression of ATPase and 5'N in their membranes. Some lymphoid cells positive for ANAE and B-G with a B-like pattern and for AcPh were recognizable in the G.C. In the M.Z. only a few lymphoid cells being ANAE+, with a T-like pattern, and AcPh+ were shown to belong to the T-cell system. In contrast, in this zone a high proportion of small lymphoid cells (64% +/- 10%) showed ANAE activity, mostly with B-like pattern. Therefore, these findings indicate that in the M.Z. a high proportion of B-cells ATPase+ and 5'N+ also display ANAE activity. By comparison of the results obtained from lymphoid tissue sections, B-CLL and immunocytoma cell suspensions and normal circulating lymphocytes we can conclude that B-ANAE-positive cells of the M.Z. do not usually appear in the peripheral blood. They circulate in large numbers only in some pathological conditions (like our reported B-CLL). Therefore, B-ANAE-positive lymphoid cells of the mantle, with a B-like staining pattern, include a wide range of subsets which exclude large lymphoid cells and plasma cells.

Detection and distribution of alfa-naphthyl acetate esterase activity in thymocytes of normal, myasthenic thymus and thymoma. Histochemical and cytochemical study in relation to E-rosetting

The extent and distribution of alfa-naphthyl acetate esterase (ANAE) activity in both normal thymuses and thymuses or thymomas from patients with myasthenia gravis were investigated by enzyme histochemistry. In all a closely similar distribution of ANAE activity was recognizable. ANAE positive thymic lymphocytes were distributed preferentially at the cortico-medullary junction and in the medulla. Their numbers at these sites were higher in myasthenic patients than in normal adults (P less than 0.001) and lowest in fetuses. The relative numbers of cells showing both ANAE activity and EN-rosette-forming capacity was lower in thymocytes than peripheral lymphocytes but was increasing higher in thymuses from fetal, adult and myasthenic patients and in thymomas. These findings are discussed in relation to the stage of maturity of thymocytes and the importance of intrathymic immunological challenge in the attainment of these cells of functional properties usually acquired in the periphery.

Role of the T-cell system in glomerulonephritis induced in rats by human serum albumin (HSA). An immunological and morphological study

The primary role of the T-cell system in immune-complex glomerulonephritis induced by intravenous weekly injections of human serum albumin (HSA) in rats has been demonstrated. The development of histological, ultrastructural and immunological glomerular alterations which are clearly recognizable in intact animals was prevented by neonatal thymectomy. In vitro tests of cellular immunity (LIF and PHA responsiveness) revealed a close relationship between the involvement of functioning T-cell subpopulations (at least T-helper) and the development of the classic glomerulonephritic pattern. In other words HSA antigen recognition by T lymphocytes, their cooperation with B lymphocytes, and the activation of the latter with related antibody response represent the immunological sequence which leads to the formation of the soluble circulating immune-complexes responsible for the glomerular injury. Our findings suggest that the same immunological sequence can represent the pathogenetic basis for many forms of glomerulonephritis in which T-dependent antigen stimulation is demonstrable. Our data are also discussed in the light of results obtained by others in immuneglomerulonephritis induced in nude athymic mice.

Analysis of human lymphocyte cell cycle kinetics in vitro by incorporation into DNA of bromodeoxyuridine

Human lymphocytes of four donors were cultured for 40 to 76 hours and harvested at 4 hour intervals. They were analysed for the number of 1st, 2nd and 3rd division metaphases using the BrdU-Giemsa technique. All 44 hours cultures showed metaphases only in their 1st division; 2nd division metaphases began to appear in 48 hours cultures and 3rd division metaphases in 64 hours cultures. Another group of lymphocytes from 4 other donors were irradiated and harvested at 72 hours. These cultures showed a decrease in the percentage of 3rd division metaphases, accompanied by an increase in the percentage of 1st division metaphases, proportional to the irradiation dose.