Search

The Authors deem it opportune to report a case of clear meningioma with the morphological, immunohistochemical and ultrastructural features of a perivascular epithelioid cell tumour.

Histological analysis has limited value to predict the biological behavior of meningiomas. In this study, we investigated the utility of indicators of cell proliferation in the evaluation of histologically benign meningiomas.For this purpose, 50 meningothelial meningiomas, 50 atypical meningiomas and 8 primary benign meningiomas with their recurrences were studied. For each case the Ki67 labeling index (LI), DNA ploidy and AgNOR were evaluated and the results quantitatively processed and assessed by computerized image analyzer.The Ki67 labelling showed a low index (11.3%) in typical meningiomas and primary meningiomas (13.6%). In contrast, it was higher in atypical (26.6%) and recurrent meningiomas (28%). Similar results were obtained for the AgNOR granule count which showed that typical and primary meningiomas had mean 1.51 - 1.49, whereas recurring meningiomas and atypical meningiomas had mean values of 1.92 and 1.98, respectively. DNA ploidy revealed in the hyperpolyploid region between 4c - 16c: 7.02% of the nuclei in primary meningiomas, 17.98% of the nuclei in recurring meningiomas and 24.63% of the nuclei in atypical meningiomas.Our results suggest that evaluation of cell proliferation using Ki67 LI, DNA ploidy and AgNOr, integrated with standard histopathology, can provide better information for a correct grading of meningiomas.

The biliary pole of the hepatocytes is formed by the canaliculus, the intracytoplasmic organelles, the pericanalicular cytoskeleton and by canalicular membranes. As a rule, the set of these sub-structures give risk to the biliary secretion. At present, the canaliculi are not considered as "fixed" structures, but rather entities that can be formed and modulated by intra and extra hepatic factors aiming of regulating the bile secretion in relation to metabolic events and to the body's requirements. To this end, a role is played by hormones, metabolites, drugs or toxic substances, etc. Data reported in the literature show that they change their profile in situations of intra-extrahepatic cholestasis. That is, they show ectasia, almost deprived of microvilli and with a dense pericanalicular matrix. On the basic of this theoretical premises, the Authors have aimed at verifying the ultrastructural features of the canaliculi in the case of chronic hepatitis showing no sign of cholestasis. The parameters taken into consideration are the same as the ones which result to be modified during cholestasis: diameter of canaliculi, number of microvilli and pericanalicular matrix. For this purpose 25 cases of persistent chronic hepatitis and 25 cases of active chronic hepatitis have been utilized without any clinical or humoral sign of cholestasis. Needle biopsy specimens of hepatic parenchyma have been studied both at the transmission electron microscopy and at scanning electron microscopy. The result obtained can be summarized as follows: 1) The canaliculi are impaired both in the cases of persistent chronic hepatitis and in those of active chronic hepatitis (they develop ectasia, with very-few microvilli and with a thickened pericanalicular matrix). 2) Within the same case, different degrees of changes have been observed. 3) The above changes can be mostly observed at the level of the canaliculi surrounded by hepatocytes which are characterized by hydropic swelling. 4) Such a correlation (canalicular changes-hydropic degeneration of the hepatocytes) permits to assume that the causes of those changes in the canaliculi are to be ascribed to alterations of the pericanalicular microfilaments.

One of the problems connected to the anatomo-clinical evaluation of ependymomas consist in the difficulty of precisely grading these neoplasms and of making a prognosis. Traditional histopathologic procedures have proven themselves unsuitable to solve these biological problems of neoplastic growth: their solution requires the identification and responsiveness of molecules that are part of cellular kinetic processes such as antigen Ki67 and the granules of AgNOR as indexes of the rDNA transcriptional activity. With the aim of contributing to the knowledge of ependymomas' grading, the Authors performed qualitative and quantitative assays on 35 cases of benign ependymomas (by means of an image analyzer) using the nuclear antigen Ki67 and the AgNOR nucleolar areas. The results thus obtained allow to draw the following conclusions: 1) The biological validity of the labeling of antigen Ki67 and the quantification of argentophilic granules in the NOR areas has once more been confirmed. 2) The expressiveness and biological significance of antigen Ki67 is finer than what can be derived from the count of AgNOR granules. 3) The level of diagnostic reliability for the differentiation between and the corresponding malignant forms is optimal; such a level falls considerably when one wishes to grade levels of benignity of malignity. 4) Such drawbacks are likely to be due to the action of heterogeneous factors which are often unrelated to the neoplasm, such as poor oxygenation, blood stream alterations, necrosis, phlogosis, nutritional conditions of the cell populations etc.

Morphologic and immunologic study were performed on the mucosa associated lymphoid tissue (MALT) of patients with allergic rhinitis. Scraping from 14 healthy subjects and 36 allergic ones were used. Besides ordinary hystological methods immunohistochemical ones wilk polyclonal antibodies were employed to study IgG, IgA, IgM, IgE and monoclonal antibodies used for B and T lymphocyte and subset T-suppressor cell identification. In a comparison between normal and allergic mucosa, the morphopathology show an accentuated edema and a slight fibrosis. Among the IgG, IgA and IgM do not show any substantial differences in the samples in normal or in allergic subjects; white traces of IgE are found in allergic patients, but are totally absent in normal ones. In the lymphocyte populations does not show any substantial changes between the two groups. Was also analyzed the mechanism and the majority of the factors by which were obtained the results.

Objective. Microcystic meningioma was originally classified as a subtype of meningioma by the World Health Organization classification of brain tumours in 1993 1, and accounts for 1.6% of intracranial meningiomas. This subtype is a variety of meningioma in which micro- and macro-cysts are diffuse. The morphologic characteristics are well defined, while the histogenetic mechanism that give rise to these patterns remain unclear. Materials and methods. The authors present an electron microscopic study of an unusual case of fronto-temporal microcystic meningioma, manifesting as history of headache, right paresis and dysphasia in a 73-year-old female. Computer tomography revealed a large hypodense mass in the left fronto-temporal region, with slight contrast enhancement. Results. Ultrastructural observation showed complex alterations among small vessels and intratumoral capillaries in a background of severe modification in vessel permeability. Conclusions. This electronic microscopy study documented that growth of the cyst was due not only to accumulation of in extracellular fluid, but also to cytolysis consequent to ingravescent hydropic degeneration.

Protecting the myocardium from the risk of acute ischemia during heart surgery is still an unsolved problem; the problem is even more open and more pressing in pediatric heart surgery. To meet this greater risk it is advisable to use a cardioplegic solution with a composition that is better suited to the particular morphofunctional conditions of the myocardium in the child, i.e., a solution offering greater protection. To this purpose the authors experimented with Celsior cardioplegic solution during heart surgery in children to evaluate the efficacy compared to the standard St. Thomas solution. In this comparative study 15 children were treated with Celsior cardioplegic solution and 15 others with St. Thomas cardioplegic solution. Each patient underwent 2 biopsies of the myocardium, the first before cardioplegic treatment and the second immediately after reperfusion. In both groups, focal lesions involving both the cardiomyocytes and the vascular-stromal structures were randomly found. The former had undergone a necrotic-regressive process with changes in the myofibrils and the mitochondria. The vascular-stromal structures showed changes in the permeability of the capillary endothelia, with interstitial edema. The results show the lesions to be similar in the 2 groups both on a quality and quantitative level.

Purpose: The aim of this study was to evaluate the clinical, neuroradiological, and neuropathological outcomes of patients treated with equine collagen foil (TissuDura®) as a dura mater substitute during cranial and spinal neurosurgical procedures. Materials and Methods: All patients treated at the Department of Neurosurgery of the Second University of Naples with TissuDura between 2005 and 2009 were included. Dural reconstruction was performed using TissuDura, overlaid 1 cm over the dural defect with additional fixation using fibrin glue. No surgical sutures were used. Patients underwent postoperative contrast-enhanced magnetic resonance scans at 1 week, 1 month, and 1 year after surgery to detect any cerebrospinal fluid (CSF) leaks, infections, inflammations, or CSF circulation in the surgical region. Results: Dural reconstruction was performed in 74 patients, including 50 patients with tumors, two with C2 neurinoma, two with acoustic neurinoma, six with Chiari I malformation, two with severe head injury, and 12 requiring spinal surgery. Clinical and neuroradiological findings were normal and no signs of graft rejection or CSF leaks at postoperative follow-up were observed. In two cases of atypical meningioma, re-operation of the dural reconstruction was performed after 1 year. No adherences between brain and neodura were detected, and histopathological investigations demonstrated dural regeneration. Conclusions: Following dural reconstructions with TissuDura without surgical sutures, no local toxicity or complications were observed for up to 1 year. TissuDura demonstrated elasticity, non-reactivity, and good adaptability. The overlay technique using fibrin glue was simple and fast. Future studies and longer follow-up are needed to confirm the efficacy of TissuDura. © 2010 Springer-Verlag.

Background Burning mouth syndrome (BMS) is a common disorder frequently affecting women past the 5th decade of age. It is characterized by oral burning, mainly involving the tongue, lip, and anterior palate, but without oral lesions or alteration showing in blood tests and/or instrumental findings. Objective We proposed to exclude alterations due to thyroid function and echographic abnormality in formulating BMS diagnosis. The aim of this study was to propose a blood and instrumental protocol including thyroid function and echography to obtain a correct BMS diagnosis. In the absence of such an assessment, a number of patients with oral burning and hypothyroidism may erroneously be considered BMS patients. Study design For this study, a group of 123 patients initially diagnosed with BMS was selected, following use of the current preliminary diagnostic protocol for BMS (study group). A further 123 patients with dental problems and without oral burning were selected as a control group. All patients were submitted to further protocol based on a study of their thyroid function and echography. Results Thirteen control patients showed some thyroid alteration compared with 85 patients of the study group. In relation to these further examinations, a therapeutic protocol based on use of thyroxine, lipoic acid, or clonazepam was applied for patients belonging to the study group. Fifty-eight patients (47%) showed hypothyroidism and were treated with thyroxine, and 37 (64%) of these showed a positive response (VAS 1 and 0). Twenty-seven patients (22%) evinced euthyroidism with an inhomogeneous parenchyma thyroid echographic pattern. These were treated with lipoic acid, and 23 (85%) of them responded positively (VAS 1 and 0). Thirty-eight patients (31%) showed euthyroidism and no echographic alteration. Only these were considered to be true BMS patients and were treated with lipoic acid. Only 10 (26%) of these patients responded positively (VAS 1 and 0). Conclusions This study reveals that subjects with thyroid alterations are often considered to be BMS patients and that hypothyroidism could be responsible for oral burning and/or dysgeusia in some supertaster subjects. For these reasons, we propose that the study of thyroid function be inserted in the diagnostic process for BMS patients.

Craniopharyngioma is a slow-growing epithelial tumor with an unpredictable tendency to recur. To verify the reliability in predicting the clinical outcome, some morphological and immunohistochemical findings were analyzed in 37 primitive tumors and in 6 recurrences (one recurred twice). All the tumors were surgically excised and all recurrences exhibited an adamantinomatous pattem; mitotic rate was low (< 10 HPF) in both recurrent and in nonrecurrent tumors. Primary tumors showed a mean posi- tivity of 1.7% (range 0.3-2%) to PCNA vs. 4.1% (range 0.3-8%) in recur- rences. The MIB—1 labelling Index was: 22.12% in primary tumors, 27.5% in recurrences, 31.3% in adult nonrecurrent tumors, and 4.1% in the pedi- atric tumor. CD34 labeling vessels/field was 9.3 in primary tumors and 9.91 in the recurrences; VEGF expression was higher in recurrences than in pri- mary tumors (40 vs. 25%). Ultrastructural analysis showed fenestrated endo- thelium with hydropic changes in VEGF-positive vessels. lack of clear correlations between morphological or immuno-staining patterns and beha- vior suggests that these features have no prognostic value in adult as well as in pediatric craniopharyngiomas. In this study, the only results that may be related to the aggressiveness of tumor is the major vascularization in the recurrent tumors in which the vessels show also ultrastrudural changes.

4-Methylpyrazole (4-MP), a specific inhibitor of alcohol dehydrogenase, exerts gastroprotection of unusually long duration in rats. We tested the hypothesis that pretreatment with 4-MP might protect the human gastric mucosa against alcohol-induced acute injury. Fourteen healthy volunteers received pretreatment with either 4-MP, 15 mg/kg body weight dissolved in 50 ml of orange juice, or placebo and 2 hr later 100 ml of 40% ethanol. The endoscopic appearance of the gastric mucosa was evaluated and scored (scale 0-5) and mucosal biopsies were obtained just before pretreatment and 30 min after ethanol for histologic examination and prostaglandin E2 measurement. In the 4-MP group the mean endoscopic injury score was significantly lower than that in placebo group, in both the body and the antrum. Histologically, 4-MP significantly reduced disruption of surface epithelium and completely prevented the deep hemorrhagic mucosal lesions. In the 4-MP group no changes in gastric mucosal PGE2 levels were detected. In rats, 4-MP did not inhibit gastric acid output, whereas it markedly increased the adherent gastric mucus evaluated by the alcian blue recovery method. When lipid peroxidation was induced by carbon tetrachloride in hepatic microsomes, 4-MP caused significant inhibition of malondialdehyde generation. We conclude that 4-MP provides significant protection of the human stomach against alcohol-induced acute mucosal injury. 4-MP, besides inhibiting the conversion of alcohol to acetaldehyde, might protect the gastric mucosa by increasing adherent gastric mucus and by scavenging free radicals.

The distribution of B lymphocytes and immunoglobulins G, A, M, and E in nasal mucosa was studied in frozen biopsy sections of nasal turbinate from 16 allergic patients and 8 controls. The immunoperoxidase technique was used with monoclonal and polyclonal antibodies. Comparative analyses of serum immunoglobulin levels were also performed. Few B lymphocytes were observed in the nasal mucosa linings in specimens from allergic and non-allergic patients. In both groups, high positivity for IgG and IgA was observed in the nasal mucosa linings in the specimens. IgM concentration was minimal in both groups. IgE was absent in the nasal turbinate specimens of nonallergic subjects, but was present discontinuously in low concentrations in 7 of the 16 allergic patients. There was no significant difference between allergic and nonallergic patients in the tissue and serum IgG, IgA, and IgM concentrations found. IgE was detected slightly in the nasal mucosa of patients with high IgE serum concentrations (greater than 1000 IU/mL) as well as in patients with very low IgE serum concentration readings. This result raises some doubt on the hypothesis concerning the local production of IgE.

Serum and tissue hepatitis B virus (HBV) markers were compared in 35 alcoholic and 23 non-alcoholic subjects affected by chronic liver disease. Seventeen point one per cent of alcoholic and 21.7% of non-alcoholic subjects had HBV tissue markers, but not serum markers, for this virus. It is therefore concluded that showing the presence of HBV tissue markers permits a better aetiological definition of hepatitis B surface antigen (HBsAg) negative chronic liver disease, both in alcoholic and non-alcoholic subjects.

A virilization syndrome in a normally menstruated 20--year-old woman, due to adrenocortical tumor, is reported. Preoperative basal hormonal study showed normal plasma gonadotropins, androstenedione (A) and cortisol, slightly elevated testosterone (T), markedly increased urinary 17 ketosteroids (17KS) excretion and plasma dehydroepiandrosterone-sulfate (DHEA-S) levels. Thus DHEA-S was the major constituent of the androgen excess. Urinary 17KS and plasma DHEA-S did not change after ACTH, whereas increased after dexamethasone (DXM)-hCG administration. PRL and LH responses to TRH and LHRH tests were exaggerated. Echotomography, pneumoperitoneum radiography and selective adrenal venous angiography showed a tumor in the left adrenal gland. After the tumor removal all abnormalities were corrected. Light and electron microscopy showed well differentiation of the tumoral cells with typical ultrastructural characteristics of androgen-secreting tissue. It is concluded that the absence of amenorrhea and of LH suppression does not exclude the possibility of an androgen-secreting tumor. Moreover, the unusual finding of slightly elevated T value may be reported to enzymatic defect at the neoplastic cellular level. Furthermore the paradoxical DXM-hCG androgen response may be due to spontaneous variations in hormone secretion by the tumor or to cell receptors alteration.

The authors have studied the histological modifications in rabbit spinal cords after injury by a 20 g weight dropping from a 10 cm height. The animals were sacrificed at various time intervals from trauma (after 30', 60', 90', 2 h, 3 h, 4 h, 5 h, 6 h). The traumatized spinal cords are characterized by edema, regressive alterations of neurons as well as of glia and of fibres, and by microcentres of myelinolysis. The prominent and very precocious presence of edema is very likely one of the main factors causing regressive alterations in the cells present in myelinolysis centres.