[Mesothelial cyst of the diaphragm. Report of a case and review of the literature]

A case of mesothelial cyst of the right hemidiaphragm in a 44 year old man is reported. Origin (most likely due to a recess of the primary coelomiatic cavity), topographical, histological and therapeutic features are discussed, stressing that it is now more frequently recognised thanks to progress in diagnostic imaging techniques. Complete surgical excision is mandatory to definitely differentiate such lesion from primary diaphragmatic neoplasm, not infrequently malignant.

[Pilomatrixoma or Malherbe's calcifying epithelioma. A case report and review of the literature]

The case of a upper extremity calcifying epithelioma of Malherbe in a 16-year-old boy is reported. Clinical and pathological features of this extremely rare tumour, arisen from hair cortex cells, are reviewed. Pilomatrixoma has been reported not only as a benign lesion, or as a low-grade malignant lesion with a tendency to recur locally, but also as a highly malignant tumour. Factors influencing clinical differential diagnosis and prognosis are discussed as well.

[A case of loco-regional recurrence of carcinoma of the male breast]

The case of a 47-year-old man surgically treated with Halsted mastectomy for breast cancer and submitted to Tamoxifen therapy for more than four years is reported. A loco-regional recurrence following withdrawal of oestrogen antagonist therapy was observed and surgically treated by local excision. Normal karyotype analysis of peripheral leucocytes, normal male phenotype of the patient, his height and the lack of family history for breast cancer, as well as a possible dysfunction of the endocrine system were considered in the aetiopathogenesis of the disease.

[Pneumatic dilatation in the treatment of esophageal achalasia]

The purpose of therapy in esophageal achalasia is to reduce the pressure at the level of the lower esophageal sphincter. In this study 26 patients (16 males and 10 females) between 30 and 50 years of age, affected by esophageal achalasia underwent esophageal dilatation with Rigiflex pneumatic dilators. A total of 40 dilatations were performed. A complete success using the Rigiflex pneumatic dilators, was achieved in 24 out of 26 patients (92.3%).

[A case of anaplastic carcinoma of the thyroid. Clinico-pathological and therapeutic aspects and review of the literature]

A case of anaplastic carcinoma of the thyroid observed in a 72-year-old female patient, admitted with previous diagnosis of Riedel's thyroiditis, is reported. Clinicopathologic features and management of this rare neoplasm are discussed and Literature is reviewed. Anaplastic cancer is a locally and systemically aggressive histologic type, occurring more frequently in older patients and in those with a history of benign and/or malignant thyroid disease. Because long-term survival was seen most commonly in well-localized anaplastic tumors, a more aggressive approach to thyroid lesions, especially in the elderly, may be warranted to improve early diagnosis and effectiveness of therapy of this nearly always lethal neoplasm. Although patients can rarely be cured, efforts should be made to control the disease locally by combined treatment including surgery and radiochemotherapy, which is found to be, at times, a national palliative therapeutic approach despite patient's advanced age.

FGF and stress regulate CREB and ATF-1 via a pathway involving p38 MAP kinase and MAPKAP kinase-2

Fibroblast growth factor (FGF) activates a protein kinase cascade in SK-N-MC cells that regulates gene expression at a cyclic-AMP response element (CRE) by stimulating the transcriptional activity of CREB. The activation of CREB is prevented by a dominant negative mutant of Ras and triggered via the same site (Ser133) that becomes phosphorylated in response to cyclic AMP and Ca2+. However, the effect of FGF is not mediated by cyclic AMP-dependent protein kinase, TPA-sensitive isoforms of protein kinase-C, p70S6K or p90rsk (all of which phosphorylate CREB at Ser133 in vitro). Instead, we identify the FGF-stimulated CREB kinase as MAP kinase-activated protein (MAPKAP) kinase-2, an enzyme that lies immediately downstream of p38 MAP kinase, in a pathway that is also stimulated by cellular stresses. We show that MAPKAP kinase-2 phosphorylates CREB at Ser133 in vitro, that the FGF- or stress-induced activation of MAPKAP kinase-2 and phosphorylation of CREB and ATF-1 are prevented by similar concentrations of the specific p38 MAP kinase inhibitor SB 203580, and that MAPKAP kinase-2 is the only detectable SB 203580-sensitive CREB kinase in SK-N-MC cell extracts. We also show that transfection of RK/p38 MAP kinase in SK-N-MC cells, but not transfection of p44 MAP kinase, activates Gal4-CREB-dependent transcription via Ser133. These findings identify a new growth factor and stress-activated signaling pathway that regulates gene expression at the CRE.

[Rare peritoneal tumors in the aged. Apropos of a case of Castleman's syndrome]

An unusual case is reported of the rare Castleman's disease localized in the retroperitoneal area in an elderly asymptomatic patient. A similar benign lymphoadenopathy of unknown etiology is generally found in the mediastinum and interests just one lymph-node that results abnormally hyperplastic. Histologically, most cases are of the hyaline-vascular type and much more rarely of the plasmacell variant. After a careful review of the literature the anatomical, pathological and clinical characteristics, the main etiopathogenetics hypotheses and diagnostic criteria are explained. The particular size of the neoformation is emphasized and also the impossibility to reach a correct preoperatory diagnosis owing to a suspect kidney parenchyma infiltration observed by RM. Also the intraoperatory report seemed to confirm the diagnostic hypothesis of a malign neoplasm infiltrating the lower pole of the kidney and which necessitated the total ablation of the retroperitoneal mass and left kidney. We concluded that the case which we have observed (the 32nd in world literature dealing with the retroperitoneal space) is not really comparable to those previously described by other authors. In fact the histopathological picture presents a series of ialino-vascular and plasmacell aspects which make any hypothesis of etiopathogenetic uncertain.

[Surgical treatment of primary carcinoma of the female breast in geriatric age. Retrospective studies of 190 cases]

On the basis of a review of 190 cases of breast cancer in elderly patients, the Authors discuss clinical and anatomopathological features for a proper surgical strategy. After an accurate evaluation of the operative risk and stage of the neoplastic disease, conservative surgical techniques or as less demolitive as possible, i.e. quadrantectomy with axillary lymphadenectomy, Madden or Patey's modified mastectomies, with respect for oncological radicality, are recommended in the elderly. The importance of an early diagnosis in reducing the frequency of locally advanced neoplasms (typical in the elderly) which if operable require Halsted's procedure, is furthermore emphasized.

[Tietze's syndrome in the elderly: description of a case and review of the literature]

A case of Tietze's syndrome in a 62-year-old man and a critical up-to-date review of the literature are reported. Although the etiology of the disease is unknown, it has been suggested that recurrent microtrauma of the anterior chest wall may be implied in the development of characteristic degenerative changes involving single or multiple upper costochondral junction. The syndrome described by Tietze has been more commonly found in older people than previously reported and it seems to be no sex or side prevalence. Because of the benign nature of this disease and its excellent prognosis, the treatment is usually symptomatic. The accumulated data stress the importance of a thorough clinical investigation and the need to exclude severe and lifethreatening conditions in the elderly.