Hodgkin Lymphoma in Children and Adolescents of Northern Greece: 25-Year Results and Long-term Follow-up

Aim of this study was to evaluate the long-term therapeutic outcome and treatment-related complications in Hodgkin disease. We reviewed the medical records of 93 patients diagnosed with classic Hodgkin lymphoma, treated, and followed-up during the last 25 years. The cohort study included 49 males and 44 females with median age 11.8 years old (range: 3.95 to 17.42 y). The most common subtype was nodular sclerosis in 47/93 (50.5%). B symptoms were present in 15/93 (16.1%). From January 2009 until December 2020, 55 (59%) patients diagnosed with Hodgkin lymphoma were treated according to European Network for Pediatric Hodgkin Lymphoma (EURONET)-PHL-C1 protocol. Concerning outcome, a total of 89/93 patients are alive. Relapse occurred in 7/93. Second malignancies are reported in a total of 5 patients, 3 solid tumors (thyroid cancer, breast cancer, and osteosarcoma), and 2 acute myeloid leukemias. The overall survival and event-free survival for the whole cohort were 95.7% and 83.9%, respectively. Disease-free survival was 92.5%. Although a considerable high fraction of patients with Hodgkin disease can achieve continuous complete remission, they are at a high risk of developing long-term treatment-related complications. High curative rates as well as prevention of late effects can be achieved by implementation of individualized treatment strategies and innovative treatments.

Prevalence of CD8/CD4 Ratio in the Fetal Thymic Parenchyme in Down’s Syndrome

Aim: The maturation of most T- lymphocyte precursors takes place within the meshwork of thymic epithelial cells. Different steps of this process can be defined by immunologic phenotyping. The prothymocytes are positive for the terminal deoxynucleotidyl transferase (TdT) and give rise to cortical thymocytes, which express CD1, CD2, CD3, CD5, and both CD4 and CD8. These CD4 and CD8 double-positive cortical thymocytes differentiate into two lineages: CD4+ or CD8+ lymphocytes of the thymic medulla, by the tenth week of gestation. Our study points towards the determination of the CD8 cytotoxic/suppressor capacity of the fetal thymus in Down’s syndrome. Experimental design: A quantitative comparison of T-lymphocytes (CD3, CD4, and CD8) in the thymic parenchyme in embryos after voluntary abortion during 2nd trimester of gestation and embryos with Down’s syndrome, respectively, was performed. Results: Our results showed: 1) A statistically significant depletion in the total number of T-cells (CD3 positive) in the cases of embryos with Down’s syndrome over those after voluntary abortion, during the second trimester of gestation (p<0.0001, t-test). 2) A significant difference in the CD8/CD4 ratio in the cases of embryos with Down’s syndrome, during the second trimester of gestation which was numerically stronger with the progress of fetal development (20th week: p<0.025; 24th week: p<0.01, chi-square). Conclusions: The occurrence of increased CD8/CD4 ratio in the cases with Down’s syndrome, in the second trimester of gestation, underlines the cytotoxic / suppressor property of the thymus in the affected fetuses.

Gains and Losses of HLA Class II (DR) and CD4 in Atypical Hyperplasia, Carcinoma in situ and Infiltrating Ductal Carcinoma of the Breast

Aim: Breast cancer is a frequent cause of death among women with gynaecologic malignancies despite the introduction of combination chemotherapy. There is therefore a need for new therapeutic strategies for patients with breast cancer, such as cellular immunotherapy. In this immunohistochemical study we analyzed the epithelial expression of major histocompatibility complex (MHC) class II (HLA-DR) on atypical and malignant primary mammary epithelial cells, as well as the magnitude of the stromal T lymphocytes (T4 subset) at the tumor site. Experimental design: The study was carried out retrospectively in tumor tissue from 82 patients with mammary lesions (31 cases of atypical ductal hyperplasia -ADH-, 12 cases of ductal carcinoma in situ –DCIS- and 39 cases of infiltrating ductal carcinoma not otherwise specified -IDC-NOS). Medullary carcinomas were not included in our investigation. Material used had been formalin fixed and paraffin embedded. Results: HLA class II (DR) was expressed in 20 of 31 ADHs (64.5%), in 4 of 12 DCISs (33.3%), and in 10 of 39 IDC-NOSs (25.6%). CD4 was expressed in 9 of 31 ADHs (29%), in 5 of 12 DCISs (42%), and in 26 of 39 IDCNOSs (67%). Conclusions: The results showed decreased epithelial expression of HLA class II (DR) and increased stromal expression of CD4, as the lesion progressed to malignancy. Gradual loss of epithelial HLA class II expression might be a manifestation of cellular differentiation from the atypical form versus the malignant one, signaling simultaneously a selective effect on the response capacity of the immune system.

Clinicopathologically problematic melanocytic tumors: a case-based review

Background

In spite of recent advances in the histopathological and molecular diagnosis of melanocytic neoplasms, a certain proportion of these lesions remain a daunting challenge for both the clinician and the pathologist.

Objectives

To emphasize the importance of close collaboration between clinicians and pathologists in case of problematic melanocytic lesions.

Patients

We report and discuss 5 problematic scenarios of melanocytic lesions, including tumoral melanosis, nevoid melanoma, lentiginous melanoma, spitzoid melanoma and BAPoma that may pose diagnostic difficulties in our practice.

Conclusions

Clinico-dermoscopic-pathological correlation, with incorporation of all the available data, in problematic melanocytic skin neoplasms is of paramount importance for accurate diagnosis.

A Time Course of Bevacizumab (Anti-VEGF) Effect on Rat Peritoneum: Relations Between Antiadhesive Action and Fibrin Regulation Enzymes

BACKGROUND

To investigate the early and late antiadhesive effect and any changes of fibrin matrix regulation enzymes on rat peritoneum, after local administration of bevacizumab.

METHODS

Rats were subjected to cecal abrasion. Bevacizumab (5 mg/kg) against placebo was given intraperitoneally. On the 2nd, 14th, and 28th postoperative days adhesions were scored, and tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1), matrix metalloproteinase-9 (MMP-9), degree of fibrosis, and angiogenesis were measured in abrased cecum and in intact parietal peritoneum.

RESULTS

Bevacizumab significantly reduced adhesions up to 15% on the 2nd, 52.5% on the 14th, and 55% on the 28th postoperative day, and significantly increased tPA concentrations in peritoneum. PAI-1 was decreased, and a significantly higher tPA/PAI-1 ratio along with an increase of MMP-9 was measured at all time points. Fibrosis and angiogenesis were significantly lower on the 14th and 28th postoperative days.

CONCLUSIONS

Local bevacizumab administration has a strong early and late antiadhesive action on rat peritoneum, mediated by changes in the tPA/PAI-1 and MMP balance in favor of fibrinolysis up to 28 days after operations.

Expression of the activation markers Blimp1, Foxp1 and pStat3 in extranodal diffuse large B-cell lymphomas

Different studies have suggested that the expression of biomarkers related to lymphoid cell activation may provide information on the behavior of DLBCL. Most studies have concentrated on nodal or a mixture of nodal and extranodal lymphomas. The differential expression and potential clinical impact of these markers in a homogeneous group of extranodal DLBCLs are not well defined. In this study, we investigated the expression of three activation markers, Blimp1, Foxp1 and pStat3, in a cohort of 35 extranodal DLBCLs homogeneously treated with R-CHOP. Immunohistochemical stains were evaluated using an immunoreactivity score on representative paraffin sections. Blimp1 was positive in 55% (19/35), Foxp1 in 60% (21/35), and pStat3 in 69% (24/35) of our cases. We did not observe any statistical differences in the expression of these markers in GCB and non-GCB tumors or in gastrointestinal and non-gastrointestinal tumors. Blimp1 expression was negatively correlated with overall survival (OS) (p=0.001) in the whole series and in the non-GCB group (Muris algorithm) (p=0.002). Foxp1 positivity and pStat3 positivity had no impact on the outcome of the patients in the global cohort, but they were associated with a better survival in the non-GCB subgroup (p=0.033, p=0.044 respectively). Multivariate analysis showed that Blimp1 expression but not COO was an independent negative prognostic factor for OS (HR=17.5, 95%, CI=2.2-141.1, p=0.007). Our results suggest that these markers are differentially expressed and have different impacts on outcome in extranodal DLBCLs compared to nodal tumors, emphasizing the need to evaluate separately these and probably other markers in these subsets of tumors.

Potential use of pericardial cTnI, Mg2+ and Ca2+ in the forensic investigation of seawater drowning in Greece: An initial assessment

The investigation of drowning constitutes one of the biggest problems in forensic practice. Elevated cardiac troponin I (cTnI) levels in biological fluids have been associated with myocardial damage, whereas increased Mg²⁺ and Ca²⁺ levels were found in cases of seawater drowning. The aim of this study was to examine the diagnostic utility of postmortem determination of cTnI, Mg²⁺ and Ca²⁺ in the pericardial fluid, in differentiating between cases of seawater drowning related to myocardial injury and those brought about by other causes. This study included 76 cases selected during a 2-year period from medicolegal autopsies. The cases were divided into three groups, according to the cause of death established based on macroscopic and microscopic evidence. The groups were: 1) seawater drowning (n=23), 2) seawater drowning with histological evidence of myocardial infarction (n=28), and 3) myocardial infarction unrelated to drowning (n=25). cTnI was determined with an enzyme immunoassay; Mg²⁺ and Ca²⁺ with standard colorimetric assays. Pericardial cTnI levels were significantly lower in group 1 compared to groups 2 and 3. In contrast, pericardial Mg²⁺ and Ca²⁺ levels were both significantly higher in groups 1 and 2 compared to group 3. Our results suggest that the postmortem determination of pericardial cTnI levels may be useful in detecting previous myocardial damage as a contributory factor in death from seawater drowning and provide independent confirmation of the usefulness of pericardial Mg²⁺ and Ca²⁺ levels for differentiating between seawater drowning and fatal acute myocardial injury unrelated to the former.

A potential impact of Helicobacter pylori infection on minimal hepatic encephalopathy pathobiology

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Impact of Helicobacter pylori on multiple sclerosis-related clinically isolated syndrome

OBJECTIVES

There are no data regarding the relationship between Helicobacter pylori infection (Hp-I) and clinically isolated syndrome (CIS) suggestive of multiple sclerosis. The purpose of this pilot study was to investigate the association between active Hp-I, confirmed by histology, and CIS and to evaluate the impact of Hp eradication on the CIS clinical course.

MATERIAL AND METHODS

We conducted a study on 48 patients with CIS and 20 matched controls. At baseline, apart from histology, serum anti-Hp-specific IgG titer, inflammatory mediators, and HLA-A, HLA-B, HLA-DR genetic polymorphisms were estimated. Hp-positive patients received standard triple eradication regimen, and all patients were followed up for 2 years.

RESULTS

The prevalence of Hp-I was significantly higher in patients with CIS (43/48, 89.6%) than in control (10/20, 50%) (P < 0.001, OR: 8.6, 95% CI: 2.4-30.8). When compared with controls, patients with CIS also showed significantly higher serum anti-Hp IgG titer and HLA-A26, HLA-A30, and HLA-B57 frequencies. Hp-positive patients also showed higher serum concentrations of inflammatory cytokines and homocysteine. At 2-year clinical endpoint, in the subgroup of CIS patients with successful Hp eradication, the number of patients who presented with a second episode was significantly lower accompanied by significant improvement in mean Expanded Disability Status Scale score.

CONCLUSIONS

Hp-I seems more frequent in a Greek CIS cohort and its eradication might delay CIS progression, suggesting a possible link between Hp-I and CIS.

A clinicopathological study of atypical leiomyomas: Benign variant leiomyoma or smooth-muscle tumor of uncertain malignant potential

Atypical leiomyomas are histopathologically recognized by moderate to severe pleomorphic atypical tumor cells showing low mitotic counts without coagulative tumor cell necrosis. The histopathological features and clinical behavior of these tumors are unclear. The surgical management of these lesions includes myomectomy and hysterectomy. The current study presents 5 cases of women with atypical leiomyomas that were managed surgically. The clinicopathological characteristics of the patients and recurrences were analyzed. The median age of the patients was 43 years old. While 3 out of 5 patients were treated by hysterectomy (with or without salpingo-oophorectomy), the remaining 2 patients were treated by myomectomy. The median mitotic index was 3 mitotic figures/10 high-power fields. The post-operative course of all patients was uneventful, and there was no evidence of local or distant recurrence in a median follow-up time of 72 months. The treatment of choice for atypical leiomyomas is hysterectomy. However, myomectomy may be an option for fertility sparing cases. A thorough consultation with regard to the uncertain behavior of such tumors and a rigorous follow-up must be offered in such patients.

Relationship between Helicobacter pylori infection and multiple sclerosis

BACKGROUND

Recent data indicate the presence of immunomodulating properties of Helicobacter pylori (Hp) (Hp Sydney Strain-1 antigen) in an experimental model of multiple sclerosis (MS), and there are limited contradictory epidemiologic data regarding Hp serology in MS patients.

METHODS

The aim of this prospective, comparative study was to validate the incidence of active Hp infection by histology and the endoscopic abnormalities, in 44 patients with relapsing-remitting MS and 20 anemic controls.

RESULTS

The overall prevalence of histologically confirmed active Hp infection in 44 MS patients was 86.4% vs. 50% in 20 matched anemic control participants (P=0.002, odds ratio 6.33, 95%CI 1.85-21.64). Concomitant diseases of autoimmune origin including hypothyroidism and ulcerative colitis were exclusively present in MS patients. Moreover, a trend of increased presence of pathological endoscopic findings such as hiatus hernia, Barrett's esophagus and duodenal ulcer disease was observed in MS patients compared with controls; Barrett's esophagus and duodenal ulcers were exclusively observed in MS patients. Likewise, Hp (+) MS patients showed exclusive presence of hiatus hernia, esophagitis and duodenal ulcer disease compared with Hp (-) MS patients.

CONCLUSION

Hp infection appears to be more frequent in MS patients. If confirmed, this might indicate either a common factor that causes susceptibilities to both MS and Hp infection or that Hp might be a causal factor for developing MS. If a causal link between Hp infection and MS is confirmed in the future, this may have a major impact on the pathophysiology and management of MS.

Aprotinin reduces oxidative stress induced by pneumoperitoneum in rats

BACKGROUND

Ischemia-reperfusion injury induced by pneumoperitoneum is a well-studied entity, which increases oxidative stress during laparoscopic operations. The reported anti-inflammatory action of aprotinin was measured in a pneumoperitoneum model in rats for the first time in this study.

MATERIALS AND METHODS

A total of 60 male Albino Wistar rats were used in our protocol. Prolonged pneumoperitoneum (4 h) was applied, causing splanchnic ischemia and a period of reperfusion with a duration of 60 or 180 min followed. Several cytokines and markers of oxidative stress were measured in liver, small intestine, and lungs to compare the aprotinin group with the control group. Tissue inflammation was also evaluated and compared between groups using a five-scaled histopathologic score.

RESULTS

In aprotinin group values of biochemical markers (tumor necrosis factor α, interleukin 6, endothelin 1, C reactive protein, pro-oxidant-antioxidant balance, and carbonyl proteins) were lower in all tissues studied. Statistical significance was greater in liver and lungs (P < 0.05). Histopathologic examination revealed significant difference between control and aprotinin groups in all tissues examined. Aprotinin groups showed mild to moderate lesions, while in control groups severe to very severe inflammation was present. Aprotinin subgroup with prolonged reperfusion period (180 min) showed milder lesions in all tissues than the rest of the groups.

CONCLUSIONS

Aprotinin reduced inflammatory response and oxidative stress induced by pneumoperitoneum in liver, small intestine, and lungs.

Upregulation of VEGF expression is associated with accumulation of HIF-1α in the skin of naïve scleroderma patients

Systemic sclerosis is a disease hallmarked by microangiopathy; the enlargement and leakage of skin capillaries in active stages develops into extensive avascular areas, clinically associated with severe tissue hypoxia and the formation of digital ulcers. Vascular endothelial growth factor (VEGF) is upregulated in all stages of the disease, with little effect on efficient neovascularization. The oxygen-regulated α-subunit of hypoxia-inducible transcription factor-1 (HIF-1α) represents a key mechanism involved in the transcriptional regulation of VEGF. The aim of this study is to investigate expression of the oxygen-regulated α-subunit of HIF-1 and VEGF in naïve scleroderma patients. For this purpose, skin biopsies (dorsal hand surface) from scleroderma patients were analyzed and compared with control skin biopsies. Immunoreactivity for VEGF was enhanced in scleroderma patients, in contrast to restricted positive immunostaining in suprabasal keratinocytes observed in normal skin. In a similar fashion, all skin biopsies from scleroderma patients were strongly HIF-1α reactive, compared with rare immunoreactivity observed in normal skin. The pattern was similar in all stages of scleroderma. These observations for the first time directly connect constitutive hypoxia with VEGF upregulation in scleroderma patients. The sequence of events needs to be precisely mapped, and the pro- and antiangiogenic switches which may interfere with efficient tissue neovascularization identified, in order to provide meaningful therapeutic strategies.

Postoperative adhesion prevention using a statin-containing cellulose film in an experimental model

BACKGROUND

Intraperitoneal adhesions are a common problem in abdominal surgery. The aim of this study was to compare the effectiveness of Statofilm, a novel antiadhesive film based on cross-linked carboxymethylcellulose and atorvastatin, with that of sodium hyaluronate-carboxymethylcellulose (Seprafilm(®)) in the prevention of postoperative intraperitoneal adhesions in rats.

METHODS

One hundred male Wistar rats underwent a laparotomy and adhesions were induced by caecal abrasion. The animals were allocated to five groups: a control group with no adhesion barrier, Seprafilm(®) group, placebo group with a film containing carboxymethylcellulose without atorvastatin, and low- and high-dose groups with films containing carboxymethylcellulose and atorvastatin 0·125 and 1 mg per kg bodyweight respectively. Adhesions were classified by two independent surgeons 2 weeks after surgery. Caecal biopsies were obtained for histological evaluation of fibrosis, inflammation and vascular proliferation.

RESULTS

All antiadhesive film groups (Seprafilm(®), placebo, low-dose and high-dose) had statistically significant adhesion reduction compared with the control group (P < 0·001, P = 0·015, P < 0·001 and P < 0·001 respectively). The low-dose Statofilm was superior to Seprafilm(®) in terms of adhesion prevention (P = 0·001). Adhesions were present in three-quarters of rats in the Seprafilm(®) group, but only one-quarter in the low-dose Statofilm group.

CONCLUSION

The data suggest that the newly developed adhesion barrier Statofilm has better results than Seprafilm(®) in preventing postoperative adhesions in rats. A low-dose atorvastatin-containing film, such as Statofilm, could be evaluated for future clinical application.

Potential implications of Helicobacter pylori-related neutrophil-activating protein

Helicobacter pylori (H. pylori) virulence factors promote the release of various chemoattractants/inflammatory mediators, including mainly the neutrophil-attractant chemokine interleukin-8 and neutrophil-activating protein (NAP), involved in H. pylori-induced gastric pathologies. Co-administration of Chios mastic gum (CMG), which inhibits H. pylori NAP, with an H. pylori eradication regimen might add clinical benefits against H. pylori-related gastric pathologies, but possibly not CMG as main therapy. Although H. pylori NAP and other H. pylori-related cytotoxins [i.e., vaculating cytotoxin (VacA)] appear to play a major role in generating and maintaining the H. pylori-associated gastric inflammatory response and H. pylori NAP is a promising vaccine candidate against H. pylori infection (H. pylori-I), concerns regarding its potential drawbacks, particularly neurogenic ones, due to possible cross-mimicry, should be considered. Possible cross-mimicry between H. pylori NAP and/or bacterial aquaporin (AQP) and neural tissues may be associated with the anti-AQP-4 antibody-related neural damage in multiple sclerosis (MS)/neuromyelitis optica patients. Moreover, the sequence homology found between H. pylori VacA and human Na+/K+-ATPase A subunit suggests that antibodies to VacA involve ion channels in abaxonal Schwann cell plasmalemma resulting in demyelination in some patients. A series of factors have been implicated in inducing blood-brain barrier (BBB) disruption, including inflammatory mediators (e.g., cytokines and chemokines induced by H. pylori-I) and oxidative stress. BBB disruption permits access of AQP4-specific antibodies and T lymphocytes to the central nervous system, thereby playing a major role in multiple sclerosis pathogenesis. Relative studies show a strong association between H. pylori-I and MS. H. pylori-I induces humoral and cellular immune responses that, owing to the sharing of homologous epitopes (molecular mimicry), cross-react with components of nerves, thereby contributing and perpetuating neural tissue damage. Finally, H. pylori NAP also plays a possible pathogenetic role in both gastric and colon oncogenesis.

Mantle cell lymphoma as a component of composite lymphoma: clinicopathologic parameters and biologic implications

Composite lymphoma is a rare circumstance in which 2 or more distinct types of lymphoma occur in a single anatomical location. Although composite lymphoma has been increasingly identified with the advent of molecular genetic techniques, this topic has only rarely been a specific focus of the medical scientific literature. In this review, we focus on mantle cell lymphoma occurring as a major pathologic component of composite lymphoma and emphasize the clinicopathologic features of these tumors and associated biologic implications. To date, 26 cases of composite lymphoma including a component of mantle cell lymphoma have been previously published. Issues of clonal relatedness between the individual lymphoma components and emerging biologic implications as well as potential diagnostic pitfalls are evaluated.

Histological presence of Helicobacter pylori bacteria in the trabeculum and iris of patients with primary open-angle glaucoma

PURPOSE

To investigate the role of Helicobacter pylori in primary open-angle glaucoma (POAG) pathophysiology by detecting its presence in eye biopsies of POAG patients during trabeculectomy.

PATIENTS AND METHODS

Fifty-one consecutive patients who underwent trabeculectomy for POAG not responsive to antiglaucoma therapy, and 35 consecutive anemic controls were examined for H. pylori presence mainly by gastric mucosa histology. In POAG patients, eye biopsies were also obtained and stained for H. pylori presence in situ.

RESULTS

Forty-three of 51 (84.3%) POAG patients and 17 of 35 (48.6%) controls were tested H. pylori positive (p = 0.0004). In 5 H. pylori-positive POAG patients, H. pylori bacteria were identified in the trabeculum and iris specimens.

CONCLUSION

For the first time, H. pylori bacteria have been detected histologically in eye biopsies of POAG patients.

Epithelial splenic cysts and life-threatening splenic rupture

BACKGROUND/AIM

Primary splenic cysts are relatively uncommon and in the majority of cases are classified as epithelial cysts which are more frequent in young patients. Most of them are asymptomatic, and they are found incidentally during imaging techniques or laparotomy. We report two rare cases of patients with epithelial splenic cysts as an incidental finding during emergency laparotomy for splenic rupture.

MATERIALS AND METHOD

The first patient was a 70-year-old man who presented with symptoms of acute abdomen after intensive cough during an episode of asthma. Emergency laparotomy findings were splenic rupture and intraperitoneal haemorrhage. A splenectomy was performed and the histological examination showed a ruptured spleen with an epithelial cyst. The second patient was a 19-year-old man who was transferred to the Emergency Department in hypovolemic shock due to intraperitoneal bleeding after a blunt abdominal injury. During laparotomy a splenic rupture was found, and an epithelial cyst.

CONCLUSION

Epithelial splenic cysts are a rare entity and they can be an incidental finding during the surgical treatment of a spleen rupture and haemoperitoneum. These cysts may be a predisposing factor to splenic rupture in cases of increased intraabdominal pressure or blunt abdominal trauma.

A 57-year-old female with a cerebellar mass

A 57-year-old female presented with recurrent episodes of nausea and vomit, as well as instability during walking. The patient had a history of uterine leiomyosarcoma, for which she underwent a hysterectomy and oophorectomy 8 months ago. CT scan revealed a calcified mass that was located in the left cerebellar hemisphere which was resected. Histologically, multiple tissue fragments displayed infiltration of cerebellar tissue by polymorphic spindle-shaped cells. The Ki-67 proliferation index was approximately 20%. The morphological and immunohistochemical data, in association with the past clinical history, were consistent with cerebellar metastasis of uterine leiomyosarcoma. Although adjuvant radiotherapy was introduced, the patient died of cardiopulmonary arrest 6 weeks after the surgical procedure. The present case adds to the body of literature being the second report of uterine leiomyosarcoma metastatic to the cerebellum.

Long-term follow-up of a non-infantile desmoplastic ganglioglioma

Desmoplastic gangliogliomas are mixed cerebral tumors traditionally reported in infants. However, a few non-infantile cases have been documented. A case of a desmoplastic ganglioglioma in a 16-year male is presented. The patient reported severe headaches. Radiological examination revealed a large mass occupying the right frontal lobe. The lesion was totally excised. Histopathological examination confirmed the diagnosis of a desmoplastic ganglioglioma. The postoperative course was excellent. At the 10(1/2) year follow-up there was no evidence of tumor recurrence. Although desmoplastic gangliogliomas have aggressive features, complete surgical removal is the treatment of choice obviating the need for adjuvant therapy.

Epstein-Barr virus associated primary intracranial leiomyoma in organ transplant recipient: case report and review of the literature

INTRODUCTION

A 45 year old female renal transplant recipient presented with headaches of 3 months duration. Clinical and radiological evaluation revealed an approximately 4x4 cm rounded, enhancing mass at the left temporal pole. At surgery, the mass had dural attachment and clinically, radiographically, and macroscopically resembled a meningioma. Histopathological analysis revealed a leiomyoma. Epstein-Barr virus (EBV) DNA was demonstrated within the tumour cell nuclei by the in situ hybridisation technique.

DISCUSSION

This is the first documentation of an EBV-associated primary intracranial leiomyoma in an organ transplant recipient and provides additional evidence of a possible relation between EBV infection and development of smooth-muscle tumours (SMT).

CONCLUSION

With increasing numbers of individuals being on long-term immuno-suppression, EBV-associated SMTs may be encountered more frequently in the future.

A rare case of malignant triton tumor with pluridirectional differentiation

An enlarging soft tissue mass was resected from the leg of a young man with neurofibromatosis type 1. Rhabdomyosarcomatous elements admixed with islands of osteoid and chondroid matrix was seen on microscopy. Based on immunohistochemistry, a malignant triton tumor, an uncommon subtype of peripheral nerve sheath tumor with rhabdomyosarcomatous elements, was diagnosed. The important feature of this neoplasm was that it showed pluridirectional differentiation to osteosarcoma and chondrosarcoma. This pathologic finding is rare and seen in only a few cases of all malignant triton tumors.

A breast fibroadenoma mimicking an extranodal deposit of Hodgkin's lymphoma in 67Ga imaging

We present the case of a young woman with classical nodular sclerosing Hodgkin's lymphoma (clinical stage IIB). During staging work-up, intense gallium-67 ((67)Ga) accumulation in a left breast lump raised the suspicion of an extranodal deposit, but biopsy favoured a benign histology. A post-treatment (67)Ga scan showed complete remission of the disease with normal tracer uptake in the left breast. However, a few months after treatment, a faint left mammary concentration of (67)Ga was observed. The breast mass was excised and histopathology was consistent with fibroadenoma. This unusual presentation is a new addition to the literature on false-positive (67)Ga findings and chemotherapy-associated tracer changes.

Cardiac tamponade as primary manifestation of angioimmunoblastic T-cell lymphoma (AILT). Coexistence with malignant mesothelioma

BACKGROUND

Cardiac tamponade (CT) as the primary clinical manifestation of lymphomas is extremely rare. Angioimmunoblastic T-cell lymphoma (AILT) is characterised by systemic disease usually presenting with generalised peripheral lymphadenopathy, hepatosplenomegaly, and bone marrow infiltration.

CASE REPORT

We report on a 59-year-old male patient with CT as initial clinical manifestation of AILT. Coexistence with malignant pleural mesothelioma was additionally revealed. Cytologic examination of pericardial fluid presented diffuse lymphoid cells and sporadic malignant mesothelial cells. AILT diagnosis was confirmed by thoracoscopic mediastinal lymph node and bone marrow biopsy. Despite the presence of pleural effusion, the diagnosis of mesothelioma was initially established by cytologic ex-amination of pericardial fluid, due to the patient's critical cardiac condition requiring prompt subxiphoid pericardiocentesis.

CONCLUSION

CT as primary clinical manifestation of AILT is very rare. This case reflects the differences in the underlying biology of AILT and consequently the vast spectrum of its clinical presentations. Coexistence of AILT with malignant pleural mesothelioma is also extremely rare.

Primary adrenal lymphoma presenting as Addison's disease. Case report and review of the literature

Primary Adrenal Lymphoma (PAL) is a very rare clinical entity. Adrenal insufficiency is a common complication of this pathology. Most patients present with clinical and laboratory findings of adrenal insufficiency and bilateral enlargement of the adrenal glands. We present a 78-year-old woman admitted to our institution with typical clinical and laboratory findings of adrenal insufficiency. Computerized tomography (CT) of the abdomen revealed bilateral enlargement of the adrenal glands. The patient was eventually diagnosed with a diffuse large B-cell lymphoma after a CT-guided needle adrenal biopsy and treated with combined immuno-chemotherapy (R-LPD-COP). Twenty months after the initial evaluation, she is in good condition, with no signs of adrenal insufficiency.

Pediatric inflammatory myofibroblastic tumor of the trachea: a case report and review of the literature

Inflammatory myofibroblastic tumors (IMTs) are relatively rare entities of a distinct histologic appearance and benign clinical course. Although these lesions have been described in virtually every anatomic location, there are few documented reports with tracheal localization. We add to the short list of pediatric IMTs of the trachea, a 13-year-old boy that was referred to our pediatric respiratory unit for evaluation of his respiratory distress. In particular, we describe the clinical and pathologic features of this patient and present a review of all reported lesions in the available literature.

Normal development of fetal hepatic haematopoiesis during the second trimester of gestation is upregulated by fibronectin expression in the stromal cells of the portal triads

OBJECTIVE

in midtrimester fetuses the principal site of hematopoiesis is the liver. In hematopoietic organs, stromal cells such as fibroblasts, epithelial cells, and macrophage-like cells develop networks to maintain hematopoiesis, i.e. hematopoietic stem cell self-renewal, proliferation, and growth, by interaction with hematopoietic progenitor cells. ECM glycoproteins produced by the stromal cells are known to play a critical role in the regulation of cell growth and differentiation. Numerous soluble and membrane-bound factors directly regulating haematopoiesis have been documented, but little is known about fetal hepatic stromal cell activity and stromal extracellular matrix protein-fibronectin, on fetal hepatic haematopoiesis. The binding of late stage erythroid cells to fibronectin has been well characterized and is believed to be critical for the terminal stages of erythroid differentiation. The intention of this article is to determine the role of fibronectin in fetal hepatic hematopoietic proliferation and differentiation in different stages of development.

MATERIAL AND METHOD

we examined and compared the immunohistochemical expression of fibronectin in the hepatic stromal portal fields in the 1st, 2nd, and 3rd trimester of gestation respectively, in relation to the appearance of CD34 progenitor hematopoietic, stromal progenitor and vascular endothelial positive cells.

RESULTS

our results demonstrated a quantitative difference in the second trimester of gestation concerning the expression of fibronectin in the connective tissue stroma of the hepatic portal fields over the equivalent expression of the protein in the first (p < 0.0001, t-test) and third trimester (p < 0.0001, t-test). Similar changes in the above period were found concerning the expression of CD34 during the second trimester of gestation, over the first (p < 0.0001, t-test) and third trimesters (p < 0.0001, t-test), suggesting a direct involvement of fibronectin in the sustaining of hematopoietic activity.

CONCLUSIONS

our data provide evidence that an ECM glycoprotein component, fibronectin, plays a relevant role in hematopoiesis through interaction between stromal cells and hematopoietic progenitor cells.

High grade primary adrenal intravascular large B-cell lymphoma manifesting as Addison disease

We report a rare case of a 68 aged male who presented with adrenal failure and was diagnosed of high grade large B-cell lymphoma primarily arising in the adrenal glands. The patient was administrated with additional chemotherapy but he passed away 7 months later due to infection in the lungs. Intravascular lymphoma should be suspected in patients with bilateral adrenal masses who present with rapidly progressive adrenal insufficiency.