[Castleman disease with lateral neck outset. Report of a clinical case]

This work presents the case of a young woman with Castleman's disease, manifest as an isolated, asymptomatic swelling in the supraclavear fossae. A fine needle biopsy was performed on the swelling and cytology on this material proved insignificant (blood cells), while CT and MRI did not show any significant vascular components nor did they provide any elements decisive for diagnosis, the neoformation being similar to a reactive lymph node. To determine the nature of the mass, the lesion was removed by cervicotomy. Histology then led to a definitive diagnosis of a hyaline vascular variant of Castleman's disease. The literature on the topic was then reviewed with an eye to otorhinolaryngological manifestations and the histological aspects and clinical-diagnostic approach are discussed in detail.

[Incidence of lymphoproliferative diseases in Northern Italy]

INTRODUCTION

In the last 6 years we have observed an increasing number of cases of lymphoma, extranodal cases being the majority over nodal ones. This fact induced us to investigate the incidence of NHL and HD in the population served by the Lecco Hospital, Department of Pathology, as well as the temporal trend from 1990 to 1995. MATERIALS AND METHODS AND DATA: All hospitals and dispensaries located in the surrounding areas of Lecco including the district of Menaggio and Morbegno are dependent on the Department of Pathology of Lecco Hospital. In fact, the surgical pathology of this area with its 272144 inhabitants converges in our department. We investigated the incidence of nodal and extranodal lymphomas in this population in the period between january 1990 and december 1995 while isolating the number of new cases reported in our files. The incidence per age, population over three-years period has been epressed as the number of cases per million population per year (cases per pmp/y).

RESULTS

285 patients aged 20 to 90 years old (mean 62.5) were selected (51% males, 49% females): they presented 141 nodal lymphomas (36 HD and 105 NHL) and 144 extranodal lymphomas of which 57 primary gastric lesions (22 males and 35 females, mean-age 63.5 in the male group (range 38-85) and 59.0 in the female group (range 31-91)). In nodal as in extranodal lymphomas the diffuse large B-cell lymphomas were the most frequent entity diagnosed, furthermore we noted an increase of incidence in all age groups in the last six years for NHL, mostly NHL HG, in contrast to decrease for HD. About gastric lymphomas, 2/3 were diffuse large B-cell lymphoma with or without low grade component, while the remaining were low grade B-cell lymphoma and only three cases were gastric peripheral T-cell lymphoma. Gastric lymphomas show a higher incidence than in other countries.

CONCLUSION

These results show an increase of the incidence of non-Hodgkin lymphomas, mainly of high grade, during six years and in all age groups. On the contrary we observe a tendency in reduction for Hodgkin Disease. Primary gastric lymphomas show a greater increase and their incidence has been estimated in 17.5 cases per 100,000 per 5 years.

[Audit of histopathology activities at the pathology departments of 7 general hospitals. 2. Response time]

A retrospective analysis of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The collected information included the date of specimen withdrawal (six labs only), receipt in the laboratory, and reporting. Time intervals between withdrawal and receipt. Two labs, received 3/4 of cases the same day, while the others had a very low prevalence of receipt. All labs but one, received 80-90% of cases within 48 hours. In one lab, 17% of cases arrived five days after from the withdrawal. Time intervals between receipt and reporting. The mean observed in the seven labs ranged from 3.1 to 6.1 days. Two labs were able to report within 24 hours, but this occurred only in 6% of their cases. The reporting prevalence within three days ranged between 5 and 64%, with a mean for the seven labs of 37%. The reporting prevalence within 6 days was about 95% (four labs), 60-70% (two labs) and 20% (one lab). All labs but one reported 95-100% of cases within ten days. Time intervals between withdrawal and reporting. Our labs were not able to report within 24 hours from the withdrawal (frozen sections excluded). The reporting prevalence within 2-3 days was about 35-40% (three labs), 16% (one lab), 2% (two labs), and within six days it was about 90% (three labs), and 61%, 38% and 14% (the remaining). These latter reported 95% of their cases within twenty days. The turnaround times we found are unsatisfactory. Probably, there are many sources of delay, and these are multifactorial. However, a major factor involved in these delays seems to be related to poor arrangements in the allocation and managing of human resources.

[Audit of histopathological activities in the laboratories of 7 general hospitals. 1. Types of resources and quantitative aspects of the workload]

Following a major reorganization of the National Health Service, competition for resources will depend to a great extent on the quality of the service offered, and audit will be of increasing importance. The present investigation deals with the quantitative aspects of the histopathology workload. A retrospective analysis of the biopsy handling of 1,000 consecutive cases was conducted in each histopathology lab of seven general hospitals. The data collected included information on specimen type, diagnosis, block/section/stain details for each specimen, as well as information about human resources, total workload and technical equipment. Among the seven labs, the histopathology workload ranged between 6,600 and 15,600 cases/year. The workload per person/year ranged between 1,400 and 2,600 (mean 1,900) for pathologists, between 800 and 3,000 (mean 1,500) for technicians, and between 2,200 and 8,300 (mean 4,400) for secretarial staff. The prevalence of biopsy fragments (endoscopic, endometrial curettage , etc.), "small" surgery (skin, appendix, gallbladder, etc.) and surgery was, respectively, between 42 and 50%, 34 and 47%, 9 and 21%. In all labs but one, 80% of cases were within 1-3 blocks; the seven labs had a mean of blocks/case ranging from 1.8 to 4.0 (total mean = 2.8). Differences in performing special stains were astonishing: one lab performed special stains in about 40%, and another in only 0.6% of cases (mean of the seven labs = 15%). Finally, the labs performed immunohistochemical stains within a range of 2.7-8% of cases (mean of the seven labs = 4.6%). The data we have collected provided baseline information on the laboratory running, and this is likely to be an integral part of laboratory administration in the near future.

[Correlations between the HPV type, DNA index and evolution of cervical intraepithelial neoplasia (CIN)]

Correlation between human papillomavirus infection and DNA ploidy in the prognosis of uterine cervical intraepithelial neoplasia. Due to the increasing frequency of human papillomavirus (HPV) infection of cervical epithelium in patients with cervical intraepithelial neoplasia (CIN) of different grades, methods are needed to identify progressive lesions. HPV typing as well as quantitative DNA analysis are possible tools to identify high-risk lesions. The aim of our study was to compare the results of "in situ" hybridization and of DNA content analysis with behavior of CIN I and CIN II lesions in 14 patients with HPV infection. Three of the 4 cases with regression of the cervical lesions were diploid, with HPV 16/18 detected in 2 of the 3. The 5 cases with progression were aneuploid, and 4 of them were HPV positive. In the 3 cases with no changes a near-diploid DNA content was observed. DNA analysis was not available in 2 cases. These preliminary results suggest that progressive CIN cases are aneuploid, and that DNA ploidy could be an objective prognostic marker.

Quality assurance in pathology. Cytologic and histologic correlation

In this study we used a computerized program to compare the cytologic and histologic diagnoses made in a three-year period with the aim of evaluating the data obtained as an index of the diagnostic accuracy of cytology in a pathology quality assurance program. Concordance between the cytologic and histologic diagnoses was observed in 83.2% of the cases. In 1.2% the cytologic diagnosis was suspected malignancy, and 78.4% of these cases were positive for tumor at histologic examination. Analysis of the data must be performed in accordance with the anatomic site involved, and discordance must be investigated by a pathologist, especially in view of the different modalities of cytologic and histologic sampling. Analytic data on the breast, bladder and lung are presented.