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Recently, many progresses have been recorded in the molecular and histogenetic characterization of the haematopoietic and lymphoid tumours, resulting in important classifying changes. As a consequence, the exact definition of lymphoma subtype requires an integration between traditional morphologic "expertise" and several bio-functional data obtained from advanced and complex ancillary techniques (immunohistochemistry, molecular biology and cytogenetics). At the same time, the data provided by gene expression profiling studies are going to deeply modify the therapies in haematological cancers. These studies are expected to allow the achievement of single-patient-tailored genic therapy; for this reason it is necessary to get biological samples of good quality. Indeed, while these progresses contribute to highlight the pathologist's diagnostic role, they should make us reflect on the state of the art of the Italian haemolymphopathology diagnostics and on its ability to cope up with the new challanges. The aim of this article is to outline a realistic picture of the present condition, and to explain the reasons for setting up, inside SIAPEC-IAP, the Haemolymphopathology Italian Group (H.I.G.). The purpose of H.I.G. will be twofold: first of all, scheduling of a series of projects so as to the haemolymphopathological diagnostic standardization; secondly, building a national network among all the pathologists involved in this exciting and complex field of the anatomic pathology.

Sixty per cent of oncologic patients need radiation therapy for cure or palliation. In fact, in most neoplastic diseases, a better local control positively impacts on disease-free survival and overall survival. The efficacy of radiotherapy depends on several factors: while some are tumor-related, others are host-related. Radiobiological phenomena are also important: ionizing radiation is responsible for cell damage (double rupture of DNA chains), mostly an indirect mechanism with the formation of free radicals. Their toxic action is enhanced by the oxygen partial pressure at the cellular level. A number of studies have confirmed that good tissue oxygenation is a function of a high hemoglobin level in the peripheral blood (Hb > or = 13 g/dL). Unfortunately, these values are rarely present in oncologic patients due to the disease-related toxicosis as well as to the therapy induced hematologic toxicity. The treatment of anemia is free of risk for the recent developments in technology which with gene cloning and the technique of recombinant DNA has allowed the production of human recombinant erythropoietin. Erythropoietin is produced by the interstitial cells of renal tubules in response to hypoxia. It prevents apoptosis and promotes erythroid proliferation and differentiation with consequent reticulocyte release and hemoglobin synthesis. It is not completely understood whether the efficacy of radiotherapy depends on hemoglobin values present at the start of irradiation (often less than 12-13 g/dL) or on the higher ones observed during and at the end of radiotherapy. Therefore, preventive systemic erythropoietin therapy in non anemic patients in terms of costs/benefits is at present non sustainable. To the contrary, in patients undergoing radiotherapy to extended fields or aggressive multimodal treatments, for the higher risk of anemia, the early use of this treatment can be hypothesized in case of initial anemia to improve therapy compliance and prevent negative conditioning of results. Keeping in mind that grade 1 minimum toxicity for red cells, according to the Radiation Therapy Oncology Group (RTOG) is equal to 11 gHb/dL we think that this value can be considered as cutoff to start erythropoietin therapy.

A new kind of instrument (Tissue-Tek Coverslipper) has been utilized by the Department of Surgical Pathology Cà Granda Hospital, Milano, for automatic mounting of cytohistological slides, using a pluristratified plastic film, instead of usual coverglasses. The introduction of this coverslipper has reduced the answer time, the technical work and the ambiental pollution. This coverslipper seems to be reliable, useful and very speedy; the optical quality of the slides was similar to conventional ones in our experience.

Preoperative assessment of calcifications is important in order to choose the correct surgical approach for mitral valve disease. To test the accuracy of echocardiography (ECHO) in the semiquantitative analysis of mitral valve (MV) calcifications we preoperatively echo-studied 66 patients, who were to undergo MV replacement of rheumatic disease. Echocardiograms were performed using a standardized method, recorded on videotape and analyzed by two independent observers. Areas of calcification were identified as dense conglomerate echoes which were brighter than those of adjacent internal structures. After removal, the MVs were evaluated by means of inspection (I), direct radiography (X-ray) and quantitative calcium extraction--EDTA spectrophotometry--(QCa). In the three methods ECHO, I and X-ray, MV calcifications were graded as absent (group 1), mild (group 2) nodular (group 3) and diffuse (group 4). Using the chi square test, no significant differences were found between the three methods, or between ECHO and X-ray, or between ECHO and I, while I grading was slightly lower than X-ray grading (P less than 0.002). Using variance analysis, no significant differences were found in QCa in the three methods within group 1 and 4, whereas significant differences were present within group 2 (P less than 0.002) and group 3 (P less than 0.001), due to the lower sensitivity of I. On the base of the observed distribution of QCa in the removed MVs, the following QCa values: a) less than 20 mg, b) 20-80 mg, c) greater than 80 mg, were considered as the selection criteria for a) absent or mild, b) nodular and c) diffuse calcifications respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

In order to assess the prognostic value of some clinicopathological factors of Gastric Lymphoma the authors reviewed 37 consecutive cases observed between 1973 and 1985 with 48 months follow up at least. Age, sex, gross features, site, histological subtype, depth of gastric wall invasion, regional lymph nodes involvement weren't useful parameters. Notable difference exists in survival according to the treatment carried out (surgery and chemoradiotherapy 100% alive & well, surgery and chemotherapy 29% a&w, surgery 17% a&w). The authors compared inflammatory cell population reactive to neoplasm to survival as possible meaningful parameter.

A very rare case of carcinoid of the testicle combined with teratoma is illustrated. In fact the literature of the last twenty years reports only eleven cases of carcinoid of the testicle, of which only four combined with teratoma. It is stressed that it is possible that these neoplasias arise on already existing teratomas which may be very small and hence not always evidenced.

A review of cases treated in 1978-82 revealed 1 case of lipid cell carcinoma of the breast out of 310 mammary carcinomas. Given the rarity of this histological type and the generally poorer than average prognosis, it seems likely that it should be considered separately from the other cases.

Two cases of glomus tumour in unusual sites are described. Their indistinct symptomatology, site and histological polymorphism are made the basis of a general discussion of the histogenesis and possible ongoing pictures of glomus tumours, the classification of which is also felt to be unsatisfactory.

470 testicular biopsies performed in prepuberal cryptorchides has been reviewed in order to assess the relationship, if any, between the morphological parameters and the prognosis of future fertility. The main parameter is the presence and the number of germinal cells, which are progressively decreasing in the following groups of patients: descended testis in monocryptorchid patients, monolateral undescended testis, bilateral undescended testis. The results observed are similar to those reported by various Authors. The age of the patients biopsied was irrelevant with respect to the results of the predictability of fertility. Other parameters than germinal cells are of no practical interest.