AB0641 An ultrasonographic study of the salivary glands in a cohort of patients affected by cryoglobulinemia vasculitis: preliminary results

Background

Xerostomia and xerophthalmia can occur in many diseases, rheumatological or not and are often reported by patients affected by cryoglobulinemia vasculitis1, particularly if related to the Hepatitis C virus infection (HCV)2. On the other hand, the Ultrasound (US) was extensively used for detecting pathological findings of the salivary glands3, possibly associated to many rheumatological diseases.

Objectives

The aim of this study was to detect, in patients affected by cryoglobulinemia vasculitis, the presence and the grade of pathological findings at level of the major salivary glands.

Methods

From January to December 2021, we enrolled consecutive oupatients patients affected by cryoglobulinemia (age ≥ 18 yo and a diagnosis of cryoglobulinemia vasculitis according to 2002 or 2011 classification criteria). Exclusion criteria were a previous diagnosis of other vasculitis/connective tissue diseases/inflammatory arthropathies, concomitant not rheumatological diseases or the intake of drugs possibly related to sicca syndrome symptoms. For each patient, the demographic, anthropometric and clinical history data, particularly about the cryoglobulinemia symptoms (either previous and ongoing) and past or current therapies have been collected. Furthermore, the values of erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], Rheumatoid Factor [RF] and C4 serum complement fraction have been recorded. The presence and the titre of the cryoglobulins have been recorded. For each patient, the Schirmer’s Test and the evaluation of the unstimulated whole salivary (UWS) flow were performed. The Schirmer Test was considered positive if < 5 mm/min at least in one eye and the UWS flow was defined pathological if < 1,5 ml/15 min.

Each patient was submitted to the US examination (Esaote MyLab Twice) of both parotid and submandibular glands. Each gland was evaluated using a semiquantitative score 0-3, according to the OMERACT definitions3. The US score was considered pathological if ≥2. Thus, at patient level, a sum dichotomous score (normal/pathological>) was provided, defining it as “pathological” if any parotid or submandibular glands scored ≥ 2.

Results

We enrolled 20 patients, all females, with a mean age of 68.8 years (SD± 13.32) and a mean disease duration of 11.76 (SD±8.25). For 18 patients was reported a previous HCV infection. 16/18 HCV + subjects reached the remission of the infection with undetectable HCV viremia. Among the patients enrolled, 10 referred at least one syndrome sicca symptom: 5 patients both xerostomia and xerophthalmia, 4 only xerostomia and 1 only xeropthalmia. Considering blood tests, the cryoglobulins were detected in 14, the ESR title was above the limit in 7 patients and the CRP in 3. The RF was detected in 12 subjects. The Schirmer’s test was pathological in 9 patients while the UWS flow was under the limit in 3. As regards the US reports, 2 patients had pathological features scored as≥2, while 7 patients showed minor alterations scored as 1. So, according to the sum score, only 2 patients were classified as pathological. No correlations were identified between the clinical and the US data.

Conclusion

In this cohort of patients with cryoglobulinemia, the US mainly showed mild pathological features at level of the parotid and submandibular structure, suggesting that syndrome sicca symptoms could be related to different pathological mechanisms in these patients, possibly strongly associated to HCV infection. Further and larger studies are necessary to confirm our preliminary data.

References

[1]Baer AN et al, Rheum Dis Clin North Am. 2018

[2]Sebastiani M et al, Current Drug Targets 2017

[3]La Paglia G et al, Clin Rheumatology 2019

Disclosure of Interests

Antonella Adinolfi Speakers bureau: BMS, Paid instructor for: Janseen, Nicola Ughi Speakers bureau: ROCHE, PFIZER, ALFASIGMA, ABBVIE, GALAPAGOS, BRISTOL MYERS SQUIBB, Paid instructor for: JANSSEN, Davide Antonio Filippini: None declared, Michel Chevallard: None declared, Laura Belloli: None declared, Cinzia Casu: None declared, Maria Di Cicco: None declared, Clizia Gagliardi: None declared, Maria Chiara Gerardi Speakers bureau: Eli-Lilly, Marina Muscarà: None declared, Elisa Verduci: None declared, oscar massimiliano epis: None declared

AB1406 TELERHEUMATOLOGY FOR IMPROVING FIRST ACCESS TO THE OUTPATIENT CLINIC: A PILOT PROSPECTIVE MONOCENTRIC ITALIAN STUDY

Background

The COVID-19 public health emergency has amplified both the potential value and the challenges with healthcare providers deploying telehealth solutions. Furthermore, outpatients may wait up to several months for their first appointment with specialists including rheumatologists for diseases other than COVID-19. In Italy it is now possible to get access to telemedicine services within the national healthcare systems, yet only follow-up visits are allowed for reimbursement purposes. Instead, it is not clear the role of telemedicine as a tool for improving first access and patient acceptance of this innovation.

Objectives

To investigate the feasibility of a ‘teletriagerheum’ service before the first visit and to identify potential benefits and disadvantages of it by comparing first face-to-face visit preceded by ‘teletriagerheum’ service to regular first visit without it.

Methods

A pilot prospective monocentric study was conducted. Consecutive patients were contacted by phone 30 days before the scheduled rheumatological first visit by administrative staff to investigate their willingness to receive 20 days before the first visit a phone call (‘teletriagerheum’ service) by a physician of the Rheumatology Unit. The ‘teletriagerheum’ service aimed at investigating the reason for the visit and at prescribing additional exams or specialistic consultations before the face-to-face first visit to facilitate the diagnosis process or anticipate the appointment in case of urgency. Socio-demographic characteristics, reason for referral, face-to-face visit duration, number of additional exams prescribed, number of definite diagnosis at first visit in the ‘teletriagerheum’ group were compared to the ones receiving regular first visit without ‘teletriagerheum’ service.

Results

In October 2021 a total of 102 patients were phone called by administrative staff: 18 (17.6%) did not answer for a maximum of three times, 9 (8.8%) responded but refused the ‘teletriagerheum’ service (6 cancelled the visit, 1 postponed, 2 for unknown reason) and 75 (73.5%) accepted the service, but 21 were not real first visits and 8 patients did not answer the call of physician. Among the remaining 46 (45.1%) pts (the ‘teletriagerheum’ group) the median call time was 11.5 minutes (IQR 5-15 min), blood exams were prescribed to 34 (74%) and instrumental exams to 8 (17.4%). Further consultation was prescribed only to 1 patient and the visit was not anticipated in any case. A preliminary diagnosis was possible in 36 (78.2%). In most of the cases (33, 76%) no difficulties were reported by the physician, in 7 (16.3%) there were difficulties in communication, in 1 (2.3%) difficulty to get the history from a patient suffering from a psychiatric disorder. Socio-demographic characteristics, Information and communication technologies skills, face-to-face visit duration were not statistically different between the ‘teletriagerheum’ group (46 pts) and the group receiving regular first visit without ‘teletriagerheum’ service (52 pts).

In the ‘teletriagerheum’ group, a lower number of blood exams (14% vs 46%, p<0.005) and a lower number of instrumental exams (25% vs 45%, p=0.04) were prescribed during the face-to-face first visit; a higher percentage of definitive diagnosis (79% vs 67%, whilst not statistically significant p=0.2) and a lower number of patients requiring a visit before 6 months (26% vs 54%, p<0.05) were observed compared to the group without teletriagerheum service.

Conclusion

These preliminary data showed that telemedicine for the first rheumatological visit was well-accepted by patients searching for rheumatology consultations and had the potential to be a tool for improving clinical diagnosis and rheumatological follow up in everyday clinical practice. A larger cohort will let us to further explore the potential benefits of telemedicine to improve accessibility to rheumatological services.

References:

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Disclosure of Interests

None declared

THU0590 WHEN RARE IS EVEN RARER: A COMPLEX CASE OF BEHCET DISEASE

Background:

Behcet disease is a rare inflammatory disorder with the unique ability to affect vessels of any size. The disease could be associated to thrombosis in both the venous and arterial compartment, and often aneurysms. In particular, the presence of aneurysms of the pulmonary artery is rarely, if ever, seen in conditions other than Behcet. Cardiac involvement, albeit uncommon, is also described and associated to a severe prognosis. The treatment is based on immunosuppressants, meanwhile the use of anticoagulants -especially when aneurysms are present- is debated.

Objectives:

To describe a complex case of Behcet disease.

Methods:

We report the case of a 45 years old man of Chinese origin who presented to A&E with fever and acute dyspnea. Blood test revealed raised ESR and CRP and raised neutrophil count. Chest X rays showed bilateral opacities suggesting pneumonia. The patient did not improve over the course of antibiotics. Later on, he presented with an episode of hemoptysis and worsening dyspnea, so he was admitted to the Intensive Care Unit. CT showed bilateral pulmonary thromboembolism and aneurysm of the pulmonary artery. Echocardiogram and cardio-MRI revealed a large, mobile thrombus within the right atrium. Extensive work-up for infections and cancer was unrevealing. ANA, ENA and ANCA antibodies were negative. On the basis of a past medical history of recurrent oral ulcers and papulopustular skin lesions that patient admitted on questioning, a diagnosis of Behcet disease was suspected. In keeping with that, HLA-B51 turned out positive. The patient was promptly started on IV steroid pulses followed by Cyclophosphamide 1 gr IV monthly for six months, then on IV anti-TNF alpha Infliximab. He was also commenced on low molecular weight heparin (LMWH) and subsequently direct factor Xa inhibitor Apixaban.

Results:

The patient improved significantly with progressive regression of the pulmonary CT changes. He was discharged and able to get back to his daily life activities. After 2 years and a half of treatment, the aneurysm was stable and the intracardiac thrombus completely cleared.

Conclusion:

This case is of particular interest because of the concomitant presence of two rare vascular complications of Behcet disease-intracardiac thrombosis (<1-2%, less than 100 cases described worldwide) and pulmonary artery aneurysm (1-2%). Prompt introduction of immunosuppressant therapy was associated with a favorable outcome with no recurrence. We could speculate that, to some extent, the concomitant use of anticoagulants may have contributed to the complete resolution of the intracardiac thrombosis.

Disclosure of Interests :

MARIA DI CICCO: None declared, oscar massimiliano epis Consultant of: yes, Speakers bureau: yes, Cinzia Casu: None declared, Antonella Adinolfi: None declared, Luisa Alvaro: None declared, Valeria Campanella: None declared, Michel Chevallard: None declared, Marina Muscarà: None declared, Mariaeva Romano: None declared, Emanuela Schito: None declared, Nicola Ughi: None declared, Elisa Verduci: None declared, Davide Antonio Filippini: None declared

Angiomyofibroblastoma-like tumors

Angiomyofibroblastomas are rare, benign, slow-growing tumors, that occurring predominantly in vulvar lesions of premenopausal women. In male patients only few cases are reported (angiomyofibroblastoma-like tumors). They occur mostly in scrotal and inguinal regions. We report a case of left scrotal angiomyofibroblastoma-like tumor in a 52-years old man. After a biopsy for histological examination, a complete surgical excision was performed. At 12 months’ follow-up the patient is asymptomatic, and no tumor signs were was found on by abdominal computed tomography.

[Angiomyofibroblastoma-like tumors]

Angiomyofibroblastomas are rare, benign, slow-growing tumors, that occurring predominantly in vulvar lesions of premenopausal women. In male patients only few cases are reported (angiomyofibroblastoma-like tumors). They occur mostly in scrotal and inguinal regions. We report a case of left scrotal angiomyofibroblastoma-like tumor in a 52-years old man. After a biopsy for histological examination, a complete surgical excision was performed. At 12 months' follow-up the patient is asymptomatic, and no tumor signs were was found on by abdominal computed tomography.

Normal neuropsychological development in children with congenital complete heart block who may or may not be exposed to high-dose dexamethasone in utero

BACKGROUND

Antenatal and postnatal treatment with dexamethasone (DEX) may negatively affect the neuropsychological development in children. Maternal anti-Ro/Sjögren's syndrome A (SSA) antibodies may also be associated with learning disabilities in offspring.

OBJECTIVE

To assess neuropsychological development in babies exposed to very high dosages of DEX in utero, whose mothers were anti-Ro/SSA positive.

METHODS

13 children with congenital complete heart block (CHB) (11 exposed and 2 not exposed to DEX) and 3 healthy siblings, all of anti-Ro/SSA-positive women, were evaluated. 11 preschool-aged children (5 boys) were assessed using Griffiths Mental Development Scales. 5 school-aged children (2 boys) were examined using Wechsler Intelligence Scale for Children-Revised to check IQ and reading tests to explore the existence of learning disabilities or dyslexia. None of the children had had major neonatal complications, although those with CHB had to be paced at different intervals from birth.

RESULTS

The children had been exposed in utero to a mean total dose of 186.6 mg DEX. IQ levels were always normal (mean IQ 105.1, standard deviation (SD) 9.5). Only one child had a learning disability, of borderline clinical significance, but this child had never been exposed to DEX.

CONCLUSION

No negative effects were found on the neuropsychological development in this cohort of children, even if they had been exposed to maternal anti-Ro/SSA antibodies and to very high dosages of DEX (much higher than those used to improve fetal lung maturity). These findings might be of interest in view of the large number of infants exposed in the past to repeated antenatal courses of steroids.

Progesterone supplement in pregnancy: an immunologic therapy?

One of the most interesting functions of the placenta is the regulation of the maternal immune response such that the fetal semi-allograft is tolerated during pregnancy. Trophoblasts are presumed to be essential to this phenomenon because they lie at the maternal-fetal interface, where they are in direct contact with cells of the maternal immune system. Trophoblasts do not express classic major histocompatibility complex (MHC) class II molecules. Surprisingly, cytotrophoblasts express more HLA-G, a MHC class Ib molecule, as they invade the uterus. Progesterone plays an important role in postovulatory regulation of the menstrual cycle. If fertilization occurs, progesterone supports implantation of the ovum and maintains the pregnancy. Progesterone has been named the 'hormone of pregnancy', because in preparing the endometrium for embryo implantation and facilitating endometrial development, it is critical to the very survival of a pregnancy. In addition, this key hormone inhibits the rejection of T cell-mediated tissue and also decreases myometrial activity and sensitivity throughout pregnancy. The cellular actions of progesterone are mediated through intracellular progesterone receptors (PRs), which are well studied gene regulators, not express classic major histocompatibility complex. The more used paradigm is relative to the alteration of relationship TH1/TH2, but the complexity of the respective distributions of cytokines at the materno-fetal interface, strongly suggest that, as useful as it certainly was for a while, the Th1/Th2 paradigm must now be considered as an oversimplification. Rather, the existing data point to sequential windows and are suggestive of a system where an extreme complexity is allied to very precise timing and tuning. They also suggest that the materno-fetal relationship is not simply maternal tolerance of a foreign tissue, but a series of intricate mutual cytokine interactions governing selective immune regulation and also control of the adhesion and vascularization processes during this dialogue. However, as shifting the immune response toward the Th2 pattern (IL-4, IL-5, IL-6) may benefit the fetus, whereas development of proinflammatory Th1 cells (secreting IL-2, IFN g, TNF a) may be harmful. Now we are working to open comprise the precise behaviour of NK populations, with the hope of obtaining a diagnostic test of the condition of abortion from 'immunological causes'.

Pregnancy outcome in 100 women with autoimmune diseases and anti-Ro/SSA antibodies: a prospective controlled study

Anti-Ro/SSA antibodies are associated with neonatal lupus but are also considered a possible cause for unexplained pregnancy loss and adverse pregnancy outcome. In a large multicentres cohort study we have prospectively followed 100 anti-Ro/SSA positive women (53 systemic lupus erythematosus (SLE)) during their 122 pregnancies and 107 anti-Ro/SSA negative women (58 SLE) (140 pregnancies). Anti-Ro/SSA antibodies were tested by immunoblot and counterimunoelectrophoresis. Mean gestational age at delivery (38 vs 37.9 weeks), prevalence of pregnancy loss (9.9 vs 18.6%), preterm birth (21.3 vs 13.9%), cesarean sections (49.2 vs 53.4%), premature rupture of membranes (4.9 vs 8.1%), preeclampsia (6.6 vs 8%), intrauterine growth retardation (0 vs 2.3%)and newborns small for gestational age (11.5 vs 5.8%) were similar in anti-Ro/SSA positive and negative SLE mothers; findings were similar in non-SLE women. Two cases of congenital heart block were observed out of 100 anti-Ro/SSA positive women. In conclusion, anti-Ro/SSA antibodies are responsible for congenital heart block but do not affect other pregnancy outcomes, both in SLE and in non-SLE women. The general outcome of these pregnancies is now very good, ifprospectively followed by multidisciplinary teams with ample experience in this field.

[Neonatal lupus: clinical features and risk of congenital cardiac heart block in newborns from mothers with anti Ro/SSA antibodies]

OBJECTIVE: To assess the prevalence of Congenital Heart Block (CHB) in newborns from anti Ro/SS-A antibodies positive mothers affected by connective tissue diseases (CTD) and to evaluate the prevalence of other manifestations of Neonatal Lupus (NL) and the electrocardiographic abnormalities. METHODS: A prospective study was conducted on 100 anti Ro/SS-A positive mothers that were followed before and during their 118 pregnancies (4 twin pregnancies and 18 second pregnancies). Counterimmunoelectroforesis (CIE) and immunoblot (IB) were used to test antibodies to extractable nuclear antigens (ENA). RESULTS: Only 2 cases of CHB (1.8%) were found among the 112 living newborns. In one case the mother with primary Sjögren's Syndrome (pSS) was anti Ro 60 and 52kD positive while in the other case the mother affected by undifferentiated connective tissue disease (UCTD) was anti Ro 60kD and anti La positive. No fetal death was due to CHB. There were no cutaneous rashes at birth while mild hepatic enzyme alterations were observed in 21 (68%) of the 31 tested newborns. In 22 healthy newborns an ECG have been registered and in 4 cases (18.2%) sinus bradycardia was found. During the follow up 7 suckling showed Cutaneous Neonatal Lupus. Moreover a six month girl developed Kawasaki Syndrome. CONCLUSIONS: The risk of delivering a child with CHB is 1.8% in anti Ro/SS-A positive mothers with CTD. This finding is extremely important in the preconceptional counseling of anti-Ro/SS-A positive women. Furthermore mild electrocardiographic abnormalities may be found in their healthy newborns.

Risk of congenital complete heart block in newborns of mothers with anti-Ro/SSA antibodies detected by counterimmunoelectrophoresis: a prospective study of 100 women

OBJECTIVE

To assess the true prevalence of congenital complete heart block (CCHB) in infants of anti-Ro/SSA-positive women known to have connective tissue disease (CTD) and, secondarily, to evaluate the prevalence of other electrocardiographic abnormalities in these newborns at birth.

METHODS

A prospective study was conducted in 4 referral hospitals. One hundred anti-Ro/SSAA-positive mothers were followed up before they became pregnant and during the index pregnancy. Counterimmunoelectrophoresis and immunoblotting were used to test for antibodies to extractable nuclear antigens.

RESULTS

Of the 100 women with anti-Ro/SSA antibodies, 2 had infants who developed CCHB in utero (2%). The CCHB was detected at 22 weeks and 20 weeks, respectively. One of the 2 mothers had primary Sjögren's syndrome (SS), and the other had undifferentiated CTD (UCTD). No case of CCHB occurred among the infants of 53 mothers with systemic lupus erythematosus (SLE). No fetal death occurred due to CCHB. In 2 centers, electrocardiography was recorded in 24 unselected newborns, and 4 were found to have sinus bradycardia.

CONCLUSION

The prevalence of CCHB in newborns of prospectively followed up women already known to be anti-Ro/SSA positive and with known CTD was 2%. This finding is useful with regard to preconception counseling of these women. The risk of delivering an infant with CCHB may be higher in mothers with primary SS or UCTD than in those with SLE. Additional electrocardiographic abnormalities such as sinus bradycardia and prolongation of the QT interval may be present in their children.

The AgNoR count in ulcerative colitis with and without dysplasia

The numbers of specific intranuclear AgNOR silver precipitates (AgNORs) and their relation to the Inflammatory Bowel Disease-Dysplasia Morphology Study Group's classification were studied in 134 colonscopic biopsy specimens of ulcerative colitis (UC) with and without dysplastic findings from 73 patients with active and inactive disease. In addition, 40 cases of colonic adenocarcinomas and 22 normal colonic mucosae were also assessed for comparison with the one-step silver staining AgNOR technique. Statistical comparison of the mean AgNOR number revealed a highly significant inter-class difference (P < 0.001) between UC without dysplasia and UC with dysplasia as well as between active and inactive UC. On the contrary, the AgNORs count did not separate colonic adenocarcinomas from UC with dysplasia either high or low grade nor these three classes from the group of UC with indefinite dysplasia. The quantitative evaluation of epithelial changes occurring in UC by the AgNOR method may help to establish the clinical management of colitis patients, in addition to qualitative morphological criteria.

Gastric mucosal mast cells in atopic subjects

Intragastral allergen provocation under endoscopic control (IPEC) allows direct observation of gastric mucosa reactions after contact with inhalant allergens that reach the stomach. We selected patients with proved atopy to Parietaria but without clinical and endoscopic signs of gastric disease, and we tested them with the specific inhalant allergen during IPEC, recording gastric macroscopic reaction and mucosal mast-cell changes in biopsy specimens. All atopic patients showed visible changes in gastric mucosa quantified as IPEC score. Mast-cell numbers detected in atopic patients (135.4 +/- 102.6/mm2 of stromal area) were significantly higher than in nonatopic subjects (59.8 +/- 25.4/mm2; P < 0.03) and were positively correlated to atopic IPEC score (P < 0.01). In addition, 6/12 atopics who had both higher mast-cell counts and IPEC score showed an intraepithelial distribution of gastric mast cells which displayed ultrastructural features of partial degranulation. It is likely that changes observed in our patients with allergy to Parietaria reflect a subclinical activation of mast cells in the gastric mucosa.

Malignant hypomelanotic melanoma of mules. A histologic, immunohistochemical and ultrastructural study of a case with unknown primary site and widespread metastases

An unusual case of malignant hypomelanotic melanoma occurred in a 15-year-old gray mantle mule with unknown primary site and widespread metastatic growth is described. An ante-mortem examination, the presence of subcutaneous nodules was noted; histologically they are constituted by spindle or polygonal-shaped tumour cells with rare black granules in the cytoplasm; the immunohistochemical procedures showed a large expression of S-100, vimentin and HMB-45 antibodies, suggesting thus a diagnosis of malignant melanoma. Ultrastructural findings, obtained on formalin-fixed paraffin-embedded material, showed characteristic melanosomes and irregular fibrillary centers in nuclei of neoplastic cells. At post-mortem examination, other nodular mostly melanotic lesions were appreciable in lungs, kidneys, brain, liver, pancreas, spleen, lymph nodes and muscles. The importance of immunohistochemical and ultrastructural findings for the differential diagnosis of this neoplasm is emphasized.

PCNA/cyclin expression in breast carcinomas: its relationships with Ki-67, ER, PgR immunostainings and clinico-pathologic aspects

By the monoclonal antibody PC10, the Authors have analyzed the proliferating cell nuclear antigen (PCNA) immunoreactivity on fixed and unfixed specimens of breast ductal (42 cases) and lobular carcinomas (15 cases) as well as in normal breast tissue adjacent to carcinomas; for all cases the post-surgical staging as well as immunohistochemical data concerning ER and PgR receptors were available. In addition, the immunohistochemical pattern of Ki-67 has been also recorded. The study documented a constant expression of PCNA in all breast carcinomas with an heterogeneous pattern whereas the immunoreactivity for Ki-67 appeared less represented and focal, so that a linear relationship between PCNA and Ki-67 immunostaining was absent. Moreover, the chi-square test failed to show any correlation between PCNA and immunocytochemical demonstration of ER and PgR receptors, dimensions of tumours, histological grade and lymph node involvement. The PCNA expression in adjacent morphologically normal breast tissue may suggest an accumulation of cyclin without a necessary induction of DNA synthesis.

Epidermoid cyst of the spleen: diagnosis suggested by fine-needle aspiration biopsy

The authors report a case of epidermoid cyst of the spleen, in which cytologic findings were characteristic and suggested this diagnosis. Histologic and immunohistochemical findings are described in the attempt to clarify the histogenesis of this cystic lesion.

The application of AgNOR technique on glycol-methacrylate embedded human normal and pathological tissues

The Authors have applied the AgNOR technique to a series of normal and pathological human tissues fixed in neutral buffered formalin and methacarnoy and embedded in glycol-methacrylate. The results show the compatibility of the AgNOR technique with this embedding medium as well as the possibility to obtain an adequate visualization of the specific silver precipitates (AgNORs) on a unique focal plane without appreciable nuclear overlap, making thus the valuation of the AgNORs less subjective.

Nucleolar organizer regions (NORs) in dysplastic and neoplastic epithelial lesions of the conjunctiva

Using a silver staining technique (AgNOR technique), we have investigated the nucleolar organizer-associated proteins (NORs) in formalin-fixed paraffin embedded conjunctival specimens of 15 intraepithelial squamous carcinomas, 10 hyperplastic-dysplastic samples and 10 control epithelial fragments; the mean number of intranuclear black dots was determined for each case. A significant difference in the mean number of NORs was found when intraepithelial squamous carcinomas were compared with hyperplastic-dysplastic lesions (P less than 0.001); in addition, normal control conjunctiva and hyperplastic-dysplastic lesions were also discernible (P less than 0.05).

AgNOR distribution in normal and dysplastic laryngeal mucosa and in laryngeal epidermoid carcinomas

Samples of normal and dysplastic laryngeal mucosa and of laryngeal epidermoid carcinomas were submitted to the AgNOR silver staining technique. AgNORs were subdivided in large (LN) and small (SN) and counted separately along their sum (TN). Overlap of values is great between normal and mildly dysplastic mucosa and between moderate and severe dysplasia. Grouping together normal with mildly dysplastic mucosa, and moderate with severe dysplasia, their mean values show minimal overlap and the differences between them are highly significant. Plotting the mean values of these two groups and of carcinomas, the linear interpolations show a clearcut increase of values.

AgNOR counts in endometrial and endocervical carcinomas

The histologic differentiation between endometrial and endocervical adenocarcinomas is a common diagnostic problem. In the present study, the distribution of nucleolar organizer regions (NOR) is evaluated in the two groups of neoplasm, but it is concluded that NOR counts do not offer any histological discriminant between endometrial and endocervical carcinomas.

Neuroendocrine lung structures and tumours: immunohistochemical study by specific markers

Out of 360 lungs or lobes surgically removed, 13 non neoplastic specimens and 16 neuroendocrine (NE) tumours are investigated with immunohistochemical methods, in order to evaluate the presence of NE structures in normal and pathological human lungs. The markers used are neuron specific enolase (NSE), chromogranin (CG) and the 80 kd antigen (80 kdAg) of NE secretory granules detected by the new monoclonal Phe-5 antibody. In non-neoplastic lung specimens, clearcut immunoreactivity for all three markers appears in NE cells, neuroepithelial bodies (NEB), NE cell-hyperplasias and dysplasias. In the same specimens 4 tumourlets with analogous clearcut immunoreactivities were also observed. The NE tumours show distinct immunoreactivity for all three antisera in the 8 well differentiated cases. The 8 poorly differentiated tumours are variably immunoreactive for NSE and present low to nil staining with antisera to CG and 80 kdAg. The immunohistochemical data are interpreted according to current views about a possible relationship between NE tumours and parent normal NE lung structures.