[Show abstract][Hide abstract] ABSTRACT: We herein have described a case of de novo gastric cancer in a renal transplant recipient with a concomitant diagnosis of gastrointestinal cytomegalovirus (CMV) disease. We hypothesize that CMV, through causing an imbalance between cell proliferation and cell death, functions as the causative agent for the progression of the gastric tumor in this case after gastric colonization. To the best of our knowledge, this is the second such case ever reported of such kind and may represent a platform for investigations aimed at understanding the possible interplay between CMV and gastric cancer.
[Show abstract][Hide abstract] ABSTRACT: Meningioangiomatosis (MA) is a rare, benign hamartomatous le-sion found in cerebral cortex and leptomeninges. It occurs mostly in 5 -15 year old children in form isolated or diffuse; the diffuse form may be associated with neurofibromatosis type 2 (NF2). The spo-radic type in the adults is less common.The patient was a 37 year-old man with a long history of frontal headache. In suspected sinusitis, the patient underwent cerebral MRI that showed hypointense lesion in the right frontal lobe with heterogeneous contrast enhancement after gadolinium administration. There were no stigmata or fam-ily history of neurofibromatosis. A right pterional approach with a supraorbital craniotomy was performed. The lesion was removed with complete remission of the headache in the postoperative time. MA enters into differential diagnosis with several other diseases and a correct diagnosis is mandatory. The total surgical removal is the treatment of choice, and the prognosis after surgery is usually excellent for the absence of recurrence in sporadic cases.
Full-text · Article · Jan 2012 · World Journal of Surgical Oncology
[Show abstract][Hide abstract] ABSTRACT: It is rare for prostate carcinoma to metastasize to the central ner-vous system. It often represents a terminal event with death in one year frequently due to the advanced systemic disease. Starting by a case report, we also reviewed the relevant literature to focus on this uncommon entity from epidemiology to clinical manifestation and therapeutic strategies. In this article, a case of multiple brain prostate metastasis is reported and a review of relevant literature is also discussed. Treatments available for intracranial metastasis in-clude neurosurgery, external beam radiation and hormonal manipu-lation. Surgery associated with whole brain radiotherapy seems to be effective in the control of brain lesions both relieving neurologi-cal symptoms and prolonging survival, even if prognosis remains dismal. From this case, we concluded that brain metastasis from prostate carcinoma is a rare, terminal event with death in one year frequently due to the advanced systemic disease. A better under-standing of the biology of prostate carcinoma will help clarify the basis for its metastasis to the brain.
[Show abstract][Hide abstract] ABSTRACT: The term “autopsy” literally means to “see for oneself”; the terms “post- mortem”, “post-mortem examination” and “necropsy” are use as synonymous. Autopsy rates have been declining worldwide since 1950s. The advances in medical technology (believed to provide greater diagnostic accuracy), economic and legal reasons justify this decline.
METHODS. We retrospectively analyzed the autopsy records from the Pathology Unit of “San Salvatore” Hospital of L’Aquila (L’Aquila, Italy) of 590 deceased people over a 10-years period (1999-2008) and compared the clinical and post-mortem diagnoses. Furthermore, we also compared our results to two previous consecutive series of, respectively, 1000 and 2000 autopsied cases performed in our Department over a 10-years and a 20-years period.
RESULTS. According to the literature, in the present study the autopsy rate (including both clinical and required by law autopsies) shows a homogeneous decline; the only exception is represent by a high number of autopsies performed in 2007. Fetal autopsies represent the 20,4% of all post-mortem examination. Of 424 adult patients, 275 were males and 149 were females, with a mean age of 77 years old at the time of necroscopy. Among fetal autopsies, congenital malformations and genomic aberrations represent the most common cause of death. It is interesting to note the high incidence of Dandy-Walker Syndrome. Among adult autopsies, we classified findings into six groups according to the cause of the death, namely: Cardiovascular diseases (Group1), Malignancies (Group 2), Digestive and Accessory Digestive Glands non-neoplastic diseases (Group 3), Respiratory diseases (Group 4), Infectious diseases (Group 5) and Miscellaneous (Group 6).
As expected, in Group 1 and Group 2 are represented the most common cause of death, with a percentage, respectively, of 54,5% and 15,5%. Group 4 collects the third most common causes of death with a percentage of 14,5, followed by Group 3 (9,9%), Group 6 (4,2%) and Group 5 (1,8%). Comparing these results with the two previous study, we should underline a relevant decline of Infectious and Digestive diseases as causes of death in favour of an increasing number of Malignancies.
The diagnoses were in total agreement in 64% of cases. The most common causes of disagreement are represented by thromboembolic events misdiagnosed as infarcts or pulmonary diseases.
CONCLUSIONS. This study underlines once again the relevant role of post-mortem examinations, not only to confirm the cause of death diagnosis but also as source of investigation and research, being the frequency of misdiagnosis not decreased significantly, despite improvements in diagnostic technology.
Thus, autopsy remains one of the most reliable methods to validate clinical diagnoses.
[Show abstract][Hide abstract] ABSTRACT: We report a rare case of herpes simplex virus (HSV) type 1B in patient with kidney transplant as a possible cause of patient death.
A 32-year-old renal transplanted Caucasian man was referred for asthenia, fever, anemia, chest pain, cough, dyspnea, myalgias, peripheral edema, acute renal failure, diffuse cutaneus and mucous vesicles, and acute weight gain. The home therapy consisted of tacrolimus, sodic mycophenolate, and steroids. Laboratory data, bronchoscopy, and bronchial mucosal biopsy revealed HSV1B. We administered antiviral and antibiotic agents and reduced tacrolimus with clinical resolution. But after 10 days from discharge, the patient was admitted for acute cardiomegaly. So using ex adiuvantibus criteria we administered antiviral therapy with complete clinical improvement.
According to the literature, posttransplant HSV1B infection is a rare but severe complication of kidney transplantation associated with poor graft survival and a high mortality. Only an early, accurate diagnosis with efficient treatment permitted resolution of the problem. Our report stresses the difficulty of HSV2B clinical diagnosis and treatment.
No preview · Article · May 2011 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Facial nerve schwannomas include only 0.8% of all intrapetrous mass lesions, and schwannomas originating exclusively from the greater petrosal nerve (GPN) are extremely rare. To date, only 13 reports have been described. In this case, the tumor was thought to originate from the GPN on the basis of clinical, radiological, and operative findings.
A 23-year-old girl presented an acute left facial palsy, a disturbance in tear secretion of the ipsilateral eye, and a left-sided conductive hypoacusia. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed an extradural mass in the left middle fossa. A subtemporal approach was performed and the lesion, originating from the proximal portion of the GPN, was excised. The post-operative course was satisfactory, except for a xerophtalmia, which was treated with artificial teardrops.
GPN schwannomas can originate anywhere alongside the course of the nerve, from its proximal segment near the facial hiatus to its distal segment near the foramen lacerum. For these reasons, it requires differential diagnosis with trigeminal nerve schwannomas or with injuries arising from the geniculate ganglion, because it can be easily confused with those lesions. However, in less severe cases, an early diagnosis can be able to preserve the function of the facial nerve by reducing iatrogenic injuries caused by surgical maneuvers.
Full-text · Article · Apr 2011 · Surgical Neurology International
[Show abstract][Hide abstract] ABSTRACT: We report a case of thrombotic microangiopathy (TM) in patient with UC and kidney transplantation.
A 59-year-old Caucasian may with a renal transplant, with atrial fibrillation and ulcerative colitis (UC), was referred for asthenia, fever (38 degrees C), anemia, colicky pain, and bloody diarrhea. The maintenance therapy consisted of CSA, sodium mycophenolate, steroids, ticlopidine, and mesalazine. Laboratory data, colonscopy, and colic mucosal biopsy revealed de novo colic TM. We administered antibiotics and antishock therapy, reducing CSA, withdrawing ticlopedine and maintaining mesalazine with the resolution of the problem.
Posttransplantation TM is an uncommon but severe complication of kidney transplantation associated with reduced graft survival and a high risk for death. Only an early, accurate diagnosis with optimal treatment permits resolution of the problem.
Full-text · Article · May 2010 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Gliomas are histologically graded by cellularity, cytological atypia, necrosis, mitotic figures, and vascular proliferation, features associated with biologically aggressive behaviour. However, abundant evidence suggests the presence of unrecognized, clinically relevant subclasses of the diffuse gliomas, both in respect to their underlying molecular phenotype and their clinical response to therapy. It is well-known that patient prognosis and therapeutic decisions rely on accurate pathological grading. Recently, it was reported that human gliomas accumulate lipid droplets during progression, suggesting a lipid metabolism impairment. Considering the crucial role of peroxisomes in lipid metabolism, in the present work we studied the expression profiles of proteins either exclusively localized to peroxisomes, such as peroxin14 (PEX14), peroxisomal membrane protein 70Kda (PMP70), acyl-CoA oxidase, thiolase, or partially associated to peroxisomes such as Hydroxymethylglutaryl-CoA reductase (HMGCoA-red) and peroxisomal-related proteins, namely PPARalpha, in human glioma specimens at different grades of malignancy. Moreover, Nile red staining of lipid droplets, thin layer chromatography (TLC) and proton nuclear magnetic resonance spectroscopy (NMR) were carried out in order to correlate the biochemical results with the lipid content of tumor tissues. The results obtained indicate that correlating the malignancy grade with the expression of peroxisomal genes and proteins, may constitute a sensitive tool to highlight possible subtypes not recognized by the classical histological techniques.
Full-text · Article · Jan 2010 · International journal of immunopathology and pharmacology
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to evaluate the evolution of a LSIL associated with p16INK4a overexpression and on the basis of this association, identify patients who would benefit from immediate treatment rather than a later follow-up. Two hundred and forty-five cervical biopsies were studied: 199 (81.2%) were classified CIN 1, 18 (7.4%) CIN 2/3 while 28 (11.4%) were not pathological. Immunohistochemistry revealed that 22 of the 217 CIN samples (11%) were positive for the p16INK4a antigen. The results of the PCR-ELISA for the research and typing of the HPV in these 22 cases were: 14 (63.6%) HPV 16; three (13.6%) HPV 31; 2 (9%) HPV 33; one (4.6%) HPV 43; one (4.6%) HPV 45; one (4.6%) HPV 18. Colposcopic and histological tests performed at four- and eight-month follow-ups in these patients revealed worsening of the initial lesion. Hence, we conclude that immediate therapy would be of benefit in these patients.
No preview · Article · Jan 2010 · European journal of gynaecological oncology
[Show abstract][Hide abstract] ABSTRACT: Uterine tumors resembling ovarian sex cord tumors (UTROSCT) are rare, usually benign, polypoid or nodular neoplasms which generally arise in the fourth to sixth decade of life. We report a case of a 74-year-old woman who presented with vaginal bleeding and remarkable uterine enlargement. Abdominal hysterectomy with bilateral salpingo-oophorectomy was performed and a diagnosis of UTROSCT was made. Immunohistochemistry is mandatory for a correct diagnosis and a panel of at least two markers of sex cord differentiation is recommended. Differential diagnoses include leiomyosarcoma, UTROSCT and ESTSCLE, mixed müllerian tumor and metastatic ovarian sex cord tumor.
Full-text · Article · Jan 2010 · European journal of gynaecological oncology
[Show abstract][Hide abstract] ABSTRACT: Intravascular papillary endothelial hyperplasia (IPEH; Masson tumor) is a vascular lesion of blood vessels, first described in 1923 by Masson, who termed it "hemangioendotheliome vegetant Intravasculaire." This lesion consists of an exuberant, usually intravascular, proliferation of normal endothelial cells and is considered to be a reactive vascular proliferation after traumatic vascular stasis. The disease frequently occurs in skin and subcutaneous tissue; occurrence in solid organs is rare. We report a rare case IPEH that recurred as a possible consequence of an acute hypertensive arterial crisis in a patient with chronic kidney failure after kidney transplantectomy. Thirty days after transplantectomy, a 49-year-old white man receiving hemodialysis had pain in the left abdominal flank and acute anemia with serious hypovolemia after a hypertensive arterial crisis. An emergency non-contrast enhanced abdominal computed tomographic scan showed a massive retroperitoneal hemorrhage. A left nephrectomy was performed for evidence of a native kidney breach with toilette of the abdominal cavity. Histologic analysis revealed that the renal lesion had several important distinguishing characteristics that confirmed the diagnosis of IPEH. This lesion is considered to be an usual form of thrombus organization that is marked by excessive papillary endothelial proliferation. In rare cases, it is present in a solid organ of the abdominal cavity especially the kidney. Intravascular papillary endothelial hyperplasia is a benign lesion but can be dangerous. Clinical, radiologic, and histologic diagnosis of IPEH is difficult.
No preview · Article · Jun 2009 · Transplantation Proceedings
[Show abstract][Hide abstract] ABSTRACT: Parotid gland metastatic tumours are rare, usually arising from a primary mucosal or cutaneous cancer located in the ipsilateral head and neck region, although metastases from a primary cancer outside the head and neck region are possible. Hepatocellular carcinoma (HCC) rarely metastasizes to the head and neck region and the parotid glands are an even more unusual site. The authors describe the case of an 82-year-old male who presented with a right parotid mass. Percutaneous incisional biopsy with histological and immunohistochemical studies suggested metastatic HCC. Radiological investigations excluded other metastatic lesions. This case illustrates the difficulties that may be encountered when seeking a definitive diagnosis of parotid gland masses and underlines the need for collaboration between clinicians and pathologists when diagnosing a parotid enlargement.
No preview · Article · Jun 2009 · International Journal of Oral and Maxillofacial Surgery
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the rate of the cervical intraepithelial neoplasia (L-SIL and H-SIL) in HIV-positive patients using cytological, colposcopic and histological examinations. The correlations between these cervical lesions, the role of HPV and the clinical and immunological aspects of HIV infection and inflammatory cervical-vaginal disease were studied. We believe that HPV infection and preneoplastic and/or neoplastic lesions occur more often in immunodepressed HIV-positive patients, and that on the grounds of the high risk of precancerous lesions in this population and the low sensibility of the Pap test, it is advisable to perform a colposcopic examination to discover early lesions that must undergo a specific biopsy.
No preview · Article · Feb 2006 · European journal of gynaecological oncology
[Show abstract][Hide abstract] ABSTRACT: Granular cell tumor (GCT) is a relatively rare neoplasm, and almost always benign in its prognostic behavior. Location of this tumor in the breast presents serious problems for differential diagnosis, both from a clinical point of view and at gross pathological examination, because of its resemblance to carcinoma. Fine needle aspiration biopsy and intraoperative frozen section examination may not be of any further help. The histogenesis of these lesions has been widely debated in the past, but no universally accepted conclusion has been reached. Most GCTs appear to be derived from Schwann cells, but many different neoplastic and non-neoplastic lesions show granular cell changes. Therefore, GCT should not be considered as a single entity but as the result of a cytoplasmic change due to still unknown metabolic alterations that may occur in various cell types. No firm conclusions can be drawn regarding the suspected hormonal influence on the development of breast GCT. The authors describe three typical cases of breast GCT that occurred in patients of different ages, and discuss the most important questions concerning this lesion.
[Show abstract][Hide abstract] ABSTRACT: Analyses of biochemical and microbiological parameters such as pH, N-nitroso compound (NOC) concentration, carcinoembryonic antigen (CEA) level, and total viable counts (TVCs), and identification of microorganisms were carried out on 65 fasting gastric juice samples obtained at endoscopy from 45 patients previously submitted to partial gastrectomy for benign peptic ulcer disease (23 Billroth I, 22 Billroth II/Reichel-Polya) and 20 normal controls. Biopsy specimens were taken to determine histology, the Helicobacter pylori status, and both tissue CEA immunoreactivity and level. Significantly higher mean pH values, NOC and CEA concentrations, and TVCs were found in partial gastrectomies compared with normal controls. In relation to surgical methods, higher mean pH values, NOC concentrations, TVCs, and anaerobic bacterial counts were observed in the juice of patients with Billroth II compared with Billroth I gastrectomies. Mild CEA immunoreactivity and apical CEA localization were found significantly more often in Billroth II than in Billroth I stumps. Intensive CEA immunoreactivity and cytoplasmatic localization were found significantly more often in Billroth I than in Billroth II stumps. Independent of the type of surgical reconstruction, higher mean NOC levels were recorded in patients with more severe histological changes and H. pylori infection. Higher mean CEA levels in gastric juice and tissue were detected in the gastric stumps with more severe histological changes. All these data suggest that high levels of NOCs in the gastric juice could be a cofactor in gastric stump carcinogenesis and determination of CEA level in gastric juice and tissue could be included as a very useful marker in quantifying this process.
No preview · Article · Jan 1999 · Journal of Surgical Research
[Show abstract][Hide abstract] ABSTRACT: A case of adenosarcoma of the uterus in a 59-year-old woman is here reported. Adenosarcoma is a low malignant potential tumor with a benign glandular and a malignant stromal component. The treatment is usually hysterectomy with bilateral salpingo-oophorectomy. Debated is the usefulness of adjuvant chemotherapy, while radiation treatment is not beneficial. Long term follow-up is necessary for these patients because of high recurrence risk, mostly in cases with myometrial invasion.
No preview · Article · Jul 1997 · Journal of experimental & clinical cancer research: CR