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A case of uterine fatty tumour of 2 cm studied by transvaginal ultrasound in a 67-year-old woman undergone totally laparoscopic hysterectomy is here presented along with an updated review of this kind of tumours. A total of 226 cases from 75 publications could be found. Traditional definitions of these tumours are here critically reconsidered. The terminology used to define these tumours is confusing and reflects main radiological and pathological points of view (uterine fatty tumours [UFT] vs. lipoma/ lipoleiomyoma). It is here stressed that these tumours by occurring in aged and overweight women are not so uncommon as generally believed, can be very well recognized, as far as they are small (< 4 cm), by transvaginal ultrasound while CT and MR become more specific for decision making in case of larger size tumours. Symptoms largely vary from none to sudden lump enlargement or bleeding or pain. An association with malignancy has been found in 10% suggesting a radical treatment (hysterectomy) in most cases.

Aims —The spectrum of microscopic lesions resulting from the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), known as chemical gastritis, remains unclear, and the variable prevalence reported in different studies makes this issue a matter of lively debate. The aim of this study was to evaluate the prevalence and importance of chemical gastritis in patients regularly taking NSAIDs. Owing to the high prevalence of Helicobacter pylori infection, particularly in subjects over 60 years of age, and in view of a possible association with damage, the presence of H pylori infection in the same tissue sample was also determined in all patients. Methods —One hundred and ninety seven subjects were enrolled, 118 of whom were receiving chronic treatment with NSAIDs and 79 of whom were controls, pair matched for age, sex, and clinical symptoms (ulcer-like dyspepsia or upper digestive tract haemorrhage). Antral biopsies taken during upper gastroduodenal endoscopy were assessed for chemical gastritis according to a modified version of Dixon9s score, and for helicobacter correlated chronic active gastritis, according to the updated Sydney system. Results —Chemical gastritis was identified in 11 patients taking NSAIDs (9%) and in four controls (5%) (p Helicobacter pylori was detected in 53 patients taking NSAIDs (45%) and in 34 controls (43%). Patients taking NSAIDs had a significantly higher number of erosions and ulcers and worse endoscores than controls. The presence of H pylori did not appear to increase histological damage, ulcer prevalence, or haemorrhagic events. Conclusions —Chemical gastritis is present in a limited number of patients regularly taking NSAIDs, and is not strongly correlated with NSAID induced damage. In many cases of peptic ulcer or upper gastrointestinal bleeding in patients taking NSAIDs, the presence of chemical gastritis or H pylori infection cannot solely account for the development of mucosal damage.

Morphea, lichen planus and vitiligo are common diseases, but seldom associated. Morphea or lichen planus in the lips have not frequently been reported, and an associated localization of both lesions in the lip mucosa is indeed a rare event. A case of morphea and lichen planus localized in the upper lip mucosa in a patient with vitiligo is reported. Immunohistochemistry revealed a clear prevalence of T-lymphocytes in the inflammatory infiltrates of morphea and in the band-like infiltrate of the lichen, a finding consistent with previous reports of morphea, lichen planus, and vitiligo. The inverse ratio found between CD8+ and CD4+ lymphocytes, compared to other reports, seems to confirm that the pathogenesis of morphea and lichen planus evolves through different stages. The present report, besides presenting a rare case, may prompt to consider a common pathogenesis among morphea, lichen planus and vitiligo.

Among malignant neoplasms of the pancreas, lymphomas have a very low incidence. Nevertheless, the dramatic difference in prognosis and treatment between pancreatic carcinoma and lymphoma stresses the importance of a correct diagnosis, especially because most lymphomas of the biliopancreatic region are low-grade B-cell type. The case observed by us shares clinical and pathological features with the few previously reported in literature, and focuses clinicians' attention on the diagnosis of this unusual neoplasm whose clinical behaviour is characterized by obstructive jaundice and overlaps with that of epithelial tumours.

Introduction. Pancreatic adenocarcinoma (PAC) remains an incurable disease. The development of a new therapy with antip185HER2 monoclonal antibodies (Trastuzumab, Pertuzumab) has been proposed although the status of HER2 gene in PAC and its correlation with clinical history remain not completely defined. We evaluated the expression of p185HER2, HER2 gene amplification and chromosome 17 centromere (CEP17) copy number in PAC. In addition, we compared p185 HER2 expression and HER2 gene status of primary PAC, matched lymph node metastasis (LMTS) and distant metastasis (DMTS). Materials and methods. We analyzed 93 cases of PAC including 31 PAC at initial diagnosis, 22 LMTS and 40 DMTS. In particular, primary tumours were matched with hepatic DMTS in two cases, with peritoneal and gastric DMTS in one case and with LMTS in eleven cases. We performed IHC, on paraffin-embedded tissues, using the PATHWAY kit by Benchmark XT system (Ventana). To evaluate patterns of membranous immunoreactivity of p185HER2, a score of 0 or 1+ was regarded as IHC negative and 2+ or 3+ as IHC positive in 10% of the tissue section. FISH was performed using the Pathvision® (Abbot) or ZytoLight kit (ZytoVision). HER2 gene amplification was defined as a mean number > 6 signals per nuclei whereas CEP17 aneuploidy by a mean number > 3 signals per nuclei. Results. We found p185HER2 positive expression in 14/93 (15.0%) (all with 2+ score), increased CEP17 with HER2 amplification in 5/93 (5.4%), increased CEP17 without HER2 amplification in 12/93 (12.9%) and disomic HER2 gene amplification in 2/93 (2.1%), of all PAC specimens analysed. In particular, p185HER2 expression was found in 1/31 (3.2%) of primary PAC, in 2/22 (9.1%) of LMTS and in 11/40 (27.5%) of DMTS. CEP17 aneuploidy was associated with HER2 gene amplification in 2/31 (6.4%) cases of primary tumours, in 1/22 (4.6%) cases of LMTS and in 2/40 (5.0%) cases of DMTS. CEP17 aneuploidy status without HER2 gene amplification was found in 1/31 (3.2%) of the primary tumours, in 3/22 (13.6%) of the LMTS and in 8/40 (20.0%) of the DMTS. Finally, disomic HER2 gene amplification was restricted to 2/40 (5.0%) of DMTS (Table 1). Therefore, we compared HER2 status between primary tumours, matched LMTS and matched DMTS. Increased CEP17 was found in 3 cases of LMTS, but not in related primary PAC. One primary PAC showed CEP17 aneuploidy, not found in matched hepatic DMTS and, in one PAC, HER2 amplification detected in primary tumour and in matched gastric DMTS was not found in matched peritoneal DMTS. Discussion. We found high heterogeneity of the HER2 status in primary PAC and between primary PAC, LMTS and DMTS. Our data suggest the need for the pathologist to evaluate more PAC specimens to define the HER2 status finalized to carry out HER2-targeted therapy.