High Incidence of Laryngeal Cancer in the Province of Torino (Italy)

The present report shows that the province of Torino, Italy, (6830 sq Km, population in 1966, 2.074.893) is a high risk area for laryngeal cancer. A total of 875 cases occurring in residents in the province were forwarded to the Cancer Registry of Piedmont (RTP) in 1965–69. A histological report was available in 67.9 % cases, while in 21.8 % the death certificate was the only document with diagnosis of laryngeal cancer (table 1). Cases were uniformly distributed throughout the 5 years covered by the study: the number of cases with death certificate only progressively decreased from 59 in 1965 to 21 in 1969 (table 3). For the purposes of the present study, the province of Torino has been divided into 3 areas, i.e. the city of Torino (population 1.107.919), the 23 suburbs (total population 340.951) and the non-metropolitan part of the province (population 626.023). Among the three areas, the relative frequency of laryngeal cancer/all malignant tumours recorded at the RTP in men was 5.78 % in the city of Torino, 6.43 % in the suburbs and 4.77 % in the non-metropolitan part of the province (table 4). The difference between the city of Torino and the suburbs was not significant (p > 0.05) while the difference both between the city of Torino and the non metropolitan part of the province and between the suburbs and the non metropolitan areas was significant (p < 0.05 and p ∼ 0.01 respectively). In other cancer registries (3) the relative frequencies of laryngeal cancer were under 2.86 % with the exception of Israel (3.24 %) and Bombay (9.26 %). In women, the relative frequency of laryngeal cancer fluctuated between 0.25 and 0.32 % in the different areas of the province of Torino, i.e. in the same order of those observed in other cancer registries with the exception of Bombay (2.07%) (3). In the province of Torino considered as a whole, age standardized annual incidence/100.000 of laryngeal cancer was 12.6 in men and 0.6 in women. Incidences truncated to ages 35–64 were 25.5 and 0.9 respectively (table 5). In men these rates are approximately 5–7 times higher than those recorded in Norway, Sweden and Denmark and about 3.5–6 times higher than those recorded in the six cancer registries operating in Great Britain. A comparison between the province of Torino and other cancer registries on age specific incidences (table 6, text-fig. 3) shows that the ratio province of Torino/other registries is relatively higher at age 35–44 than later in life. This is considered as evidence of an increase of the environmental carcinogenic load in the province of Torino during recent years. In men, age standardized incidences and incidences truncated to ages 35–64 were slightly but not significantly higher in the city of Torino than in the suburbs. On the other hand, in both the city of Torino and the suburbs they were 1.5–1.7 times higher than in the non-metropolitan part of the province (table 5). The difference concerned mainly age groups over 55 (text-fig. 2). However, the incidence of laryngeal cancer truncated to ages 35–64 in the non-metropolitan part of the province of Torino was still 7.2 times higher than in the rural population of Norway and 2.1–4.1 times higher than in the six cancer registries operating in Great Britain (3). This suggests that factors connected with life in the metropolitan area of Torino (such as air pollution) are a minor cause of the excess of laryngeal cancer in the province of Torino.

Increase of Mortality Kate of Cancer of the Larynx in the Town of Torino and in Italy since 1951

Mortality rates of cancer of the larynx in the town of Torino, in the whole of Italy and in France during 1950–71 are reported. Age standardized mortality rates as well as mortality rates truncated to the period 35–64 years of age are reported in Table 1 for males and in Table 2 for females. Graph 1 represents age specific mortality rates for cancer of the larynx in the three areas in 1966–67. Graphs 2, 3 and 4 report mortality rates in males in the three ares for cohort of birth. All rates are annual/100.000. An increase of mortality for cancer of the larynx in men is well documented in the town of Torino. From 1951 to 1966 the mortality rate truncated to age 35–64 increased from 6.3 to 12.0. The proportion of mortality for cancer of the larynx/mortality for all cancers during the same period increased from 3.1 % to 5.4%. In Italy, the mortality rate in men aged 35–64 was 6.5 in 1952 and 9.3 in 1967: during the same period the proportion of mortality for cancer of the larynx/mortality for all cancers increased from 3.8 % to 4.4 %. In France, the tendency to an increase of mortality for laryngeal cancer after 1951 was absent or debatable, although both the mortality rates of cancer of the larynx and the proportion of mortality for cancer of the larynx/mortality for all cancers were consistently higher than in Italy or in Torino. However, in 1966–67 at ages 35–44 the mortality rate for cancer of the larynx in men was higher in Torino than in France (Graph 1).

[Aggressive digital papillary adenocarcinoma: a case report]

AIM

We describe a case of Aggressive Digital Papillary Adenocarcinoma, a rare skin neoplasm with acral location.

RESULTS

The patient, a 66 year old man, presented with an ulcerated mass of the fifth toe of the left foot, 4.4 cm in size. Histologically the tumour was characterized by a solid-cystic structure, with extensive papillary component, comedo necrosis and focal eccrine differentiation. Immunohistochemistry showed diffuse positivity for cytokeratins AE1/AE3 and 7, and, focal staining for Muscle Specific Actin, Vimentin and EMA. Chest CT scan showed the presence of a single pulmonary node, whose cytological features were consistent with a metastatic disease.

CONCLUSIONS

The clinico-pathological features of the present are similar to those previously reported in the literature and confirms the aggressive nature of this neoplasm.

[Mineral fibers and bladder cancer. Morphological and minerological investigations in a subject without professional exposure]

It is confirmed that occupational and paraoccupational exposure to mineral fibres, particularly asbestos fibres, plays a fundamental role in the induction of lung cancer and pleural mesothelioma. The possible association with other human cancers (e.g. larynx cancer, gastro-intestinal cancer, uro-genital cancer and emolinfopoietic cancer) is not yet demonstrated, even if some mineral fibres are identified in tissues different from the lung ones, such as kidney, bladder, and some biological fluids (e.g. urine of subjects with occupational exposure to asbestos). The possibility of damage caused to tissues in consequence of exposure to low concentration of mineral fibres (e.g. environmental exposure) has still to be defined. In this work we report the results of a mineralogical study by means of scanning electron microscopy with microprobe of a case of bladder cancer in a subject without professional exposure to mineral fibres where asbestos bodies are identified by optical microscopy.

[Littoral hemangioma of the spleen]

The authors report a rare case of littoral hemangioma of the spleen (LHS) accompanied by a revision of the literature on the argument. A male 65-year-old patient was referred to their attention with suspected ultrasonographic diagnosis of lymphoma with a splenic localisation. The complete CT diagnosis led to suspected splenic angioma. During surgery, anatomopathological analysis of the biopsy revealed LHS. The pathological anatomy showed lesions ranging in size from small foci to large nodules which almost completely replaced the splenic parenchyma. These areas were made up of vascular canals or axes that imitate splenic sinuses and have irregular lumen, often appearing as papillary projections and cyst-like spaces; they are bordered by high (cylindrical) endothelial cells that project into the vascular lumen and reveal hemophagocytosis; there is very little mitotic activity. The patient was discharged 7 days after surgery. The authors underline the extreme rarity of this neoplasm and the virtual absence of symptoms, although some cases report signs of hypersplenism, including platelet deficiency and anemia. The diagnostic iter must take care to exclude other pathologies affecting the spleen, including lymphoma, metastases and primary malignant splenic tumours. Lastly, a differential diagnosis must be made with the malignant variant, littoral hemangiosarcoma of the spleen.

[Angiolipoma of the cecum]

The paper reports a case of angiolipoma localised on the ileocecal valve. No cases of intestinal angiolipoma have been reported in the literature. The authors analyse the anatomopathological diagnostic criteria used, together with the clinical characteristics of a pathology which, even when examined macroscopically, resembles a malignant neoplasia of the colon. The authors conclude by underlining the importance of histological diagnosis for a correct surgical choice.

[Tubal carcinoma. Clinical and anatomo-pathologic considerations on an unusual lesion]

Tubal carcinoma is the rarest neoplasia of the gynecological tract; it is found during the course of abdomino-gynecological surgery with an incidence of 1:1000. The authors report a case of papilliferous tubal carcinoma which was brought to their attention having not been recognised earlier. In fact, diagnosis was made at an advanced stage during the course of emergency surgery 2 days after hospitalisation. Intraoperative histological tests resulted in bilateral adnexectomy (without apparent damage to the tubes) as well as colostomy on the transverse colon due to stenosis of the sigmoid caused by serofibrinous peritonitis. The final histological analysis of the part removed confirmed the intraoperative diagnosis.

[Retroperitoneal paragangliomas. Considerations on a internephro-caval case]

A case of paraganglioma situated between right renal vein, right renal artery and inferior vena cava is here with described. The report constitutes the rise to frame with precision the tumor according with WHO classification. Moreover criteria are to be discussed for nature and seat diagnosis, as well for the choice of the best way of access.

[Transrectal polypectomy using a TEM (transanal endoscopic microsurgery) technique]

The paper describes the removal of a broad-based tubulo-villous adenoma from the middle rectum using a transanal endoscopic microsurgical technique. This procedure, which was introduced by Buess, Thess and Hutterer in 1983, represents an alternative to the classic transanal technique, compared to which it is more accurate, and to the trans-sacral and transperitoneal methods compared to which it is less invasive.

Correlations between rectal mucosa cell proliferation and the clinical and pathological features of nonfamilial neoplasia of the large intestine

An in vitro study of proliferative activity as shown by immunohistochemical detection of the uptake of bromodeoxyuridine was run on rectal biopsies from 400 patients with nonfamilial large bowel neoplasia: 200 adenoma; 150 adenocarcinoma; 50 adenoma plus adenocarcinoma. The controls were 400 subjects with negative personal and family histories of colorectal neoplasia. The number and height distribution of bromodeoxyuridine positive cells were determined by dividing the crypt into five longitudinal compartments. The total labeling index and the labeling index of each compartment were higher in all three groups compared with the controls. In subjects with adenoma, total labeling index and labeling index values were correlated with tumor size and decreased in function of the duration of the polyp-free colon state. The major zone of DNA synthesis had shifted to the intermediate and surface crypt compartments in all three groups. This stage II abnormality was more marked in adenoma patients with a high degree of dysplasia and in those with adenoma plus adenocarcinoma. Hyperproliferation and the proliferative compartment shift are cytokinetic abnormalities that coexist in the flat rectal mucosa of patients with colorectal neoplasia. Nonetheless, they are independent, controlled by different factors, and are expressions of different biological aspects of large bowel carcinogenesis.

Needle biopsy of submucosal lesions of the gastrointestinal tract

Needle biopsy of submucosal lesions is an important addition to the diagnostic capabilities of gastrointestinal endoscopy. A series of 22 cases is described employing a guillotine needle to diagnose submucosal lesions, 4 of which were infiltrating adjacent carcinomas. The specimens obtained were sufficient for firm histological diagnosis in 20 cases. There were no complications apart from minor bleeding in 1 case.

Late cytokinetic abnormalities in irradiated rectal mucosa

Late cytokinetic changes of the colonic crypt epithelium after radiation therapy were investigated. A monoclonal antibody to bromodeoxyuridine (anti-BrdU MAb) was used in tissue specimens previously incubated with BrdU to show S-phase cells by immunohistochemical technique. Endoscopic rectal biopsies were taken from 30 patients previously treated with radiotherapy for gynaecological cancer and from 50 patients with comparable but untreated neoplasms, as controls. Number and height distribution of S-phase cells were evaluated by dividing each crypt column into 5 equal longitudinal compartments. No statistically significant differences were found in total Labelling Index (LI) between controls and irradiated mucosa, whereas LI per crypt compartment, percentage of labelled compartments and percentage of BrdU-positive cells in the middle and superficial portions of the crypt were significantly higher in patients submitted to radiation therapy. This kinetic abnormality corresponds to a progressive shift of the major zone of DNA synthesis to the upper third of the crypt as a late reaction to radiation and represents an early step in the histogenesis of colorectal cancer. These results lend support to the view that there is a higher risk of colorectal carcinoma after pelvic irradiation.

Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential

Adenomas that contain early invasive carcinoma (ACIC) represent the earliest form of clinically relevant cancer of the colorectum in most patients. In order to assess the incidence of nodal metastases of ACIC, we studied 31 patients in whom the colon was resected after endoscopic polypectomy (EP) done from 1975 to 1987. We also reviewed the pathologic features reported in individual cases and in literature series of ACIC with lymph node metastases published from 1958 to 1986. The lymph node metastatic potential of ACIC is relatively high, ranging from an average value of 8.5% in the literature of to 16.1% in our own study, and is equivalent to the range of 10%-17% that occurs in colorectal carcinomas that invade the submucosa. When an ACIC is seen in an EP specimen in which the polypectomy margin is normal, the decision as to whether the patient should enter a follow-up protocol or have radical surgical resection is determined by the assessment of the probability of the occurrence of nodal metastases. According to several authors, certain histopathologic features make it possible to distinguish between an ACIC with a high-risk of nodal metastases versus those with a low-risk. The most relevant pathologic parameters include the state of the resection margins, the grade of the invasive carcinoma, and the presence or absence of vascular invasion. Of 351 cases of ACIC that were operated on, derived from 16 literature series, 45.6% were high-risk cases and 8.5% had lymph node metastases. In our group of high-risk ACIC that had surgical resection subsequently, the lymph node metastatic rate was 35.7%. Our results help to estimate the nodal metastatic potential of early colorectal carcinomas and stress the importance of adequate pathologic evaluation in order to assess metastatic risk in these patients accurately.

Colorectal adenomas containing invasive carcinoma. Pathologic assessment of lymph node metastatic potential

Adenomas that contain early invasive carcinoma (ACIC) represent the earliest form of clinically relevant cancer of the colorectum in most patients. In order to assess the incidence of nodal metastases of ACIC, we studied 31 patients in whom the colon was resected after endoscopic polypectomy (EP) done from 1975 to 1987. We also reviewed the pathologic features reported in individual cases and in literature series of ACIC with lymph node metastases published from 1958 to 1986. The lymph node metastatic potential of ACIC is relatively high, ranging from an average value of 8.5% in the literature of to 16.1% in our own study, and is equivalent to the range of 10%-17% that occurs in colorectal carcinomas that invade the submucosa. When an ACIC is seen in an EP specimen in which the polypectomy margin is normal, the decision as to whether the patient should enter a follow-up protocol or have radical surgical resection is determined by the assessment of the probability of the occurrence of nodal metastases. According to several authors, certain histopathologic features make it possible to distinguish between an ACIC with a high-risk of nodal metastases versus those with a low-risk. The most relevant pathologic parameters include the state of the resection margins, the grade of the invasive carcinoma, and the presence or absence of vascular invasion. Of 351 cases of ACIC that were operated on, derived from 16 literature series, 45.6% were high-risk cases and 8.5% had lymph node metastases. In our group of high-risk ACIC that had surgical resection subsequently, the lymph node metastatic rate was 35.7%. Our results help to estimate the nodal metastatic potential of early colorectal carcinomas and stress the importance of adequate pathologic evaluation in order to assess metastatic risk in these patients accurately.

Histological aspects and healing rates of gastric ulcers treated with omeprazole 20 mg once daily or ranitidine 150 mg B.I.D

The aim of this double blind trial was to compare omeprazole 20 mg once daily with ranitidine 150 mg b.i.d. in treatment of benign gastric ulcer, evaluating both rates and histological aspects of the ulcer healing process. Eighteen patients were randomized, 9 to each treatment; one patient (ranitidine group) was excluded from the analysis because of malignant ulcer. Omeprazole appeared to be more effective than ranitidine in healing gastric ulcer. A more rapid relief of symptoms was observed in the omeprazole group than in the ranitidine group. Both drugs reduced chronic atrophic gastritis (with a trend in favour of omeprazole), while omeprazole showed a prompter activity on the components of acute inflammation.

Balloon cell melanoma: a report of two cases

Two cases of balloon cell malignant melanoma of the skin are reported. The first lesion was pigmented, the second was amelanotic. Histologically, the tumor mass was dermal and intraepidermal and almost exclusively composed of balloon cells. Many of the clear cells demonstrated postivity with the S-100 protein immunostaining. The problems of clear-cell tumor differential diagnosis are discussed.

Immunohistochemical study of epithelial cell proliferation in hyperplastic polyps, adenomas, and adenocarcinomas of the large bowel

A monoclonal antibody to bromodeoxyuridine was used in tissue specimens previously incubated with bromodeoxyuridine to show S-phase cells by immunohistochemical technique. Biopsy specimens of normal mucosa (n = 10), hyperplastic polyps (n = 10), adenomas with low-grade dysplasia (n = 20), adenomas with high-grade dysplasia (n = 10), and invasive adenocarcinomas (n = 10) of the large bowel were studied. Labeling index and cell proliferative patterns were analyzed. No statistically significant difference was found in labeling index between normal mucosa and hyperplastic polyps or between adenomas with high-grade dysplasia and adenocarcinomas. The labeling index was significantly lower in normal mucosa and in hyperplastic polyps than in adenomas and adenocarcinomas (p less than 0.001). The difference in labeling index between adenomas with high-grade dysplasia and low-grade dysplasia was also statistically significant (0.01 less than p less than 0.05). In normal mucosa and in hyperplastic polyps the proliferative zone was confined to the lower two-thirds of the crypt; no kinetic activity was found in the upper portions of the crypt or in surface epithelium. In adenomas the labeled cells were either present in the upper third or scattered along the whole axis of the crypt and in the surface epithelium. Labeling patterns in invasive carcinomas were similar to those observed in adenomas with high-grade dysplasia. The difference in proliferative patterns between hyperplastic polyps and adenomas supports a different significance of the two polypoid lesions in the histogenesis of large bowel cancer; our results confirm the subsequent steps of the adenoma-carcinoma sequence. Immunohistochemical labeling patterns observed with monoclonal antibody to bromodeoxyuridine in polypoid and cancer lesions of the large bowel are similar to those described by autoradiographic studies.

Large bowel adenomas containing carcinoma--a diagnostic and therapeutic approach

Adenomas containing invasive carcinoma of the large bowel form the majority of early colorectal cancers. Conclusive histological diagnosis of early colorectal cancer depends on two conditions; first, the whole lesion must be examined and second the resection margin must border on healthy tissue. The presence of certain histopathological features makes it possible to distinguish between cases with high and low risk of having lymph node metastases. Sixty-six adenomas containing invasive carcinoma are reported. They comprised 3.15% of 2,095 adenomas removed by colonoscopic polypectomy during the same period. Five cases were lost to follow-up. Forty-nine patients considered to be at low risk of having lymph node metastases have been treated by endoscopic polypectomy only with a rigorous follow-up regime including CEA estimation, ultrasonography and total colonoscopy at regular intervals. In none have distant metastases been found on follow-up examinations at a mean duration of 3 years. Two of these cases have developed a metachronous colorectal carcinoma and 15 (30.5%) have metachronous adenomas. Two low risk patients with no tumour found in the operative specimen have undergone major surgical resection. Ten high risk cases have been referred for major surgery and lymph node metastases have been found in four (40%). The need for careful histological examination for lymphatic and veinous invasion is stressed by the presence of this finding in all four high risk patients with involved lymph nodes.

Inverted urothelial papilloma: a lesion with malignant potential

Two cases of inverted urothelial papilloma are presented. In the first case the inverted papilloma was in the ureter and varying degrees of cellular atypia were demonstrated on histology: 7 years later, a single bladder lesion consisting of papillary transitional cell carcinoma and inverted papilloma developed in the same patient. In the second case a bladder tumor consisting of inverted papilloma mixed with papillary infiltrating transitional cell carcinoma was detected. The peculiar morphological findings, histogenesis and biological behavior of inverted urothelial lesions are discussed.

Clinico-pathological features of collagenous colitis: case report and literature review

Collagenous colitis is a newly identified condition, with clinical features of chronic watery diarrhea and abdominal pain. Histologically the main characteristic is the presence of a thick collagen band below the surface epithelium. Collagenous colitis occurs in adults, especially women. Endoscopy reveals no particular changes in the intestinal mucosa. Symptoms may persist for years with periods of remission and recurring acute attacks. The cause of this condition is still unknown, and because of no real knowledge only symptoms can be treated, usually with little success.

Coloscopic polypectomy in diagnosis and management of cancerous adenomas: an individual and multicentric experience

Of 1696 endoscopically removed polyps in the authors' series 62% were adenomas and 31 showed invasive carcinoma. 8 patients were not available for follow-up, and 7 underwent surgical resection with negative findings. There was no evidence of recurrent cancer in the remaining 16 over a 1-6 year span of follow-up, although one unrelated rectal carcinoma and an adenoma were found. By combining the data of 10 Italian Centres, 44 further patients were available, who had had endoscopic polypectomy as the only management of cancerous adenomas, adding no additional example of recurrent carcinoma. It is concluded that endoscopic polypectomy can, providing strict histological criteria are satisfied, provide definitive resection of some cancerous adenomas. A detailed follow-up regime including physical examination, occult blood testing, repeated endoscopy, paired tumour antigen levels and ultrasonography has been used to confirm the absence of recurrence in our series.