Search

This paper presents the exploratory analysis of an action-research into dropout prevention in an Italian secondary school. By taking into account the representations of teachers, students and parents, different activities of peer education have been implemented during the school year in a city of Sardinia in order to promote school success. The study is based on a mixed-methods design, including focus groups with teachers, students and parents, as well as classroom observations. The action-research consists of different interventions: firstly, the participants’ representations of school dropout have been collected; then, a specific program of peer education has been proposed through activities of role-playing, simulations, brainstorming, and improvement of life skills (during training meetings with the participants). Thereafter, the action-research has been qualitatively analysed, with the findings indicating possible directions of re-creating school practices that could have potential benefits in preventing dropout.

Objective: To correlate various types of hyperplastic lesions of the ovarian surface epithelium with primary disease of the female genital tract., Methods: Using whole-organ multiple sections of the ovary, we studied 200 hysterectomy and bilateral salpingo-oophorectomy specimens distributed into four groups: cases without hyperplastic or neoplastic disease in the tube, uterus, or vagina; those with contralateral epithelial ovarian tumors; those with endometrial adenocarcinomas; and those with polycystic ovary disease., Results: We found a high frequency of hyperplastic and metaplastic changes in the surface epithelium or in the inclusion cysts in ovaries with contralateral epithelial ovarian tumors (92%), endometrial adenocarcinomas (76%), and polycystic ovary disease (68%) compared to ovaries without hyperplastic or neoplastic disease (22%). These changes were frequently associated with intracystic papillae and psammoma bodies similar to those observed in epithelial tumors. The inclusion cysts were unrelated morphologically to signs of preceding ovulation, but were related to deep crypts of the ovarian epithelium and to stromal hyperplasia., Conclusions: The hyperplastic and metaplastic changes of the surface epithelium and related inclusion cysts can be considered morphologic precursors of common epithelial tumors. Similar changes are found as a response to a hormonal ovarian or extraovarian stimulus, which may play an important role in ovarian carcinogenesis.

What is the prognostic significant of the histomorphology in the small cell carcinomas of the lung? After the WHO classification of the lung cancer (1981), several studies criticized the subdivision of the small cell carcinoma in three sub-types (oat-cell, intermediate cell and combined types). The role of histology in the prognostic predition has been devaluated. In order to verify the prognostic value of the morphology of the small cell types of lung cancer, we performed a multivariate analysis in 62 patients. The survival rate was analytically compared with the following parameters: nuclear maximum diameter, nuclear form, nuclear chromatism, chromatine distribution, presence of nucleolus, evidence of cytoplasm. The results showed that none of these parameters are able to express a prognostic value. According to the recent studies, we think that the small cell carcinoma of the lung is a neoplasia with a multiform histologic pattern. Differences observed in clinical management are not correlate with the morphology, but with other biological parameters still unknown.

In recent years, borderline epithelial tumors of the ovary have been investigated by morphometric techniques to allow for a differential diagnosis from benign and malignant neoplasms. In order to enhance this discriminant power, we have applied a new analytical procedure to the evaluation of the nuclear shape in epithelial ovarian tumors. Sixty nuclei of benign ovarian serous neoplasms, 60 nuclei of serous borderline tumors and 60 nuclei of serous carcinomas (18 cases in all) were examined using the software system SAM (Shape Analytical Morphometry). The morphometric procedure consisted of three different phases: (i) extraction of nuclear fundamental curve: this is a function curve giving the smoothing of the original contour by two parametric equations (separately for x and y values as dependent variables); (ii) evaluation of nuclear contour irregularities by Fourier analysis; (iii) evaluation of nuclear shape asymmetry by SAE (Shape Asymmetry Evaluator): this is the ratio between the length of a segment of a parabola interpolating the original curve points and a straight line joining its extremities for a 180 degrees barycentric rotation according 10 degrees steps. All the obtained independent parameters were submitted to statistical analysis. Nuclei of borderline tumors showed dimensional parameters which were intermediate between those of benign and malignant tumors. Both the asymmetry and the irregularities of nuclear contour were greatest in carcinomas.

Laryngeal Intraepithelial Neoplasia (LIN) is graded in 3 levels (LIN Grade I-II-III), corresponding to the classic aspects of mild, moderate and severe dysplasia-in situ carcinoma, on the basis of the number and position of mitoses and of the undifferentiated or atypical cells limited to the basal or extended to the intermediate or the superficial layers of epithelium. In order to reduce the subjective imprecision of these parameters we have applied not only traditional dimensional evaluators but also procedures of analytical morphometry to the nuclear shape. By using the software system S.A.M. (Shape Analytical Morphometry) we have examined fifty nuclei of the basal layer in LIN grade I, II and III, fifty nuclei in normal laryngeal mucosa and fifty nuclei in invasive carcinoma of the larynx (twenty-five cases in all). Normal and dysplastic nuclei did not show any dimensional differences, while the carcinomatous nuclei were significantly larger. An asymmetric distortion of the nuclear contour was noted in the moderate and severe dysplasia, but not in carcinomatous cells. Also the Fourier parameters, increased in severe dysplasia, decreased dramatically in carcinomatous cells which showed nuclei with minor contour irregularities than the normal cells. These findings outline the discriminative power of the analytical morphometry and suggest a possible correlation between nuclear shape and cell biology.

Several experiences induced us to consider genital HPV infection as an expression of a local immunodeficiency. The aim of our study was to research the effect of immunotherapy on the lymphocyte subpopulations and Langerhans cells in vulvar condyloma. Twenty women with persistent vulvar condylomata, treated with 2,000,000 IU/die of beta-interferon for 15 days, were submitted to vulvar biopsy before and 2-5 months after medical treatment. The frozen sections obtained were assayed with the following monoclonal antibodies: OKT 4 (T helper lymphocytes), OKT 8 (T suppressor lymphocytes), OKB 7 (B lymphocytes) and S-100 protein (Langerhans cells). Using a morphometric evaluation, the average number of both intraepithelial and stromal lymphocyte subsets and of the intraepithelial Langerhans cells was assessed. In all the biopsies preceeding the medical treatment we found a low number of T helper lymphocytes both in the epithelium and stroma, with inversion of T4/T8 lymphocyte ratio and rare presence of Langerhans cells. In patients with a good therapeutic response (50-100% of condyloma reduction) we observed an increase in intraepithelial T4 lymphocytes and a decrease in both intraepithelial and stromal T8 lymphocytes. In cases with persistent disease after therapy, the histological pattern was similar to that observed in the first biopsy, with the exception of a significant increase in the average number of Langerhans cells. Our data correlate the clinical response to the immunotherapy with the histology of lymphocyte subsets in the vulvar condylomata. The increase in Langerhans cells observed in patients with negative response may be interpreted with a probable inability of these cells to promote the immune reaction.

In order to enhance the discrimination power in the field of serous ovarian tumors, we applied the software system SAM (Shape Analytical Morphometry) to the analytic studies of biological forms. Besides the usual dimensional evaluations (perimeter, area, maximum diameter and shape index), this procedure permits the description of the nuclear form using analytical parameters: 1) extraction of nucleus fundamental curve; that is a functional curve giving the "smoothing" of the original contour by two parametric equations (separately for x and y values as independent variables); 2) evaluation of nuclei contour irregularities by Fourier analysis; 3) evaluation of shape asymmetry by SAE (Shape Asymmetry Evaluator); that is the ratio between the length of a segment of a parabola interpolating the original curve points, and a straight line joining its extremities for a 180 degrees barycentric rotation according 10 degrees steps. All parameters resulted to be independent and were submitted to multivariate discriminant analysis. We studied 180 nuclei from 18 cases of serous ovarian tumors, (6 benign, 6 borderline and 6 malignant tumors). With respect to the dimensional parameters, the application of analytical morphometry permitted us to reduce the minimum percentage error in the discrimination of the different classes. In fact, in the distinctions of benign and malignant nuclei, the minimum percentage error was 13.30%, against the 18.3% error when using dimensional morphometry. Furthermore, in the comparison of malignant and borderline nuclei there was a reduction of error from 23.3% to 22.5%, and in the comparison of benign and borderline nuclei, the error was reduced from 37.5% to 30%.(ABSTRACT TRUNCATED AT 250 WORDS)

The presence of inflammatory reaction, plasma cells, and eosinophils in peritumoral connective tissue and in neoplastic stroma was evaluated with morphometrical method in 181 patients affected by laryngeal carcinoma. A logistic multiple regression model was applied making it with the use of an independent variable represented by the "infiltrating" or "expansive" types of tumor growth, in order to evaluate the probability of nodal metastatsis of each parameter. The results suggest an inverse correlationship between plasma cells and inflammatory infiltration and incidence of nodal metastatsis only in the comparison of the extreme conditions: those with scarce infiltration versus the ones with large infiltration. Inflammatory or plasmacellular infiltration may represent both a defense mechanism against cancer and an aspecific or allergic reaction. The eosinophilic infiltration shows no value in the prevention of nodal involvement.

A multivariate analysis with a logistic regression model was performed in 181 cases of patients affected by laryngeal cancer, in order to evaluate the histologic tumor factors in predicting metastatic risk. The patterns used were: grading, localization, extension to the extralaryngeal structures, mode of growth. Nodal metastases are less influenced by the localization and the differentiation grade of the tumor. Cancer extended to the extralaryngeal tissues and with "infiltrating" type of growth are significantly correlated with nodal involvement. Multivariate analysis seems to be the best method to identify the exact value of each histological parameter used in prognosis of laryngeal carcinoma.

16 cases of secondary ovarian tumors observed from 1977 to 1986, and in which the primary neoplasms involved other organs outside the genital tract or the breast, are studied. The observations concerned 13 metastases of the gastro-intestinal tract cancer (6 typical Krukenberg tumors, 3 "tubular" Krukenberg tumors, and 4 non-Krukenberg tumors), 1 urinary bladder cancer, 1 pancreatic cancer, and 1 tumor of unknown origin (probably an amelanotic melanoma). The histological diagnosis was very difficult in patients with no evidence of the primary malignancy, or in patients in whom the metastases simulate a concomitant primary ovarian tumor. The characteristic histological findings, histochemistry, and immuno histochemistry may suggest a correct diagnosis in most of situations.

The ovarian surface epithelium and that of related inclusion cysts were studied in 50 women with ovarian polycystic disease and they were compared with our preceding observations performed on women with endometrial carcinoma (n = 50) and on women without any hyperplastic or neoplastic genital tract pathology (n = 50). In 16 women (32%) the ovarian epithelium with normal aspect was found on the surface of the ovary and in inclusion cysts. In the remaining 34 women (68%) surface papillomatosis, hyperplastic and metaplastic changes were present on the ovarian surface and/or in the inclusion cysts. These findings were similar to those observed in the group of women with endometrial adenocarcinoma, while the surface epithelium was often normal in the control group. Our observations confirm the hypothesis of a hormonal influence in the hyperplastic and metaplastic modifications of the ovarian epithelium and in the related common epithelial tumors of the ovary.

The presence of cytokeratins, IgA, alphafetoprotein (AFP), beta-Human Chorionic Gonadotropin (HCG), Carcinoembryonic antigen (CEA) and Epithelial Membrane Antigen (EMA) were immunohistochemically researched with a PAP method in 19 cases of endocervical adenocarcinoma. AFP and HCG were always absent, while the low and median molecular weight cytokeratins were present in 18 case (95%). These findings confirm the hypothesis of the tumoral histogenesis from the reserve cell of the endocervical epithelium. In 11 case (60%) there was a strong positivity of IgA in the lymphocytes surrounding the tumor nests, in the neoplastic cells and in the endoglandular secretion: this may represent a sign of an immune response of the patients to the tumoral antigens. CEA was present in 8 cases and EMA in 12 cases, with a unique expression: CEA positive cases showed no evidence of EMA and case with EMA positive cells were negative for the presence of CEA. Only in one case CEA and EMA were contemporaneously present. The possible interpretation of these findings is discussed.