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Massive ovarian edema is a rare cause of ovarian enlargement in young women. This article describes the case in a nine-year-old girl without signs of virilization or early puberty. The patient underwent laparotomy and a right oophorectomy was performed. The final pathology was massive ovarian edema. Awareness of this rare and benign lesion in young women and pediatric patients may allow a conservative management avoiding oophorectomy in some cases.

A case of persistent infestation of the scalp due to Dermanyssus gallinae.--Infestation due to Dermanyssus gallinae, the common red mite of poultry, in a country-woman aged 69 years from Crevalcore (Emilia-Romagna region, Northern Italy), is described. The case was unusual either for its location, the scalp, and for its persistence, 9 months. Specimens of the mite were also found in the henhouse adjacent to the patient's house. Apparently the woman recovered by means of daily washing of camomile tea.

Following on from their review of 1995 (Pampiglione et al.), the authors present an update of human cases of dirofilariasis due to Dirofilaria (Nochtiella) repens (Nematoda, Filarioidea, Onchocercidae) reported in the world literature. Cases of the parasitosis published from 1995 to 2000 are reported country by country. The essential data are presented in tabular form and the clinical, parasitological, histopathological, epidemiological features are analysed. 372 new cases spread over 25 countries are thus added to the list published in 1995. The countries most affected are Italy, Sri Lanka, some republics of the ex-Soviet Union. The age of the patients varied from 4 months to 100 years, the majority being in their 40s. There was virtually no difference in incidence between sexes. The parasite appeared most frequently in the upper half of the body, particularly in the head and ocular region and also in the upper limbs. Cases of visceral involvement are also reported. Of the various forms of human dirofilariasis, that due to D. (N.) repens is confirmed to be the most important as regards not only the number of subjects affected and the wide geographical distribution but also the variety of organs involved, notably the lungs, the male genitals and the female breast, invariably leading to a wrong diagnosis of malignant tumour. In man, the zoonosis may be described as emerging: whereas until the middle of the last century only a few dozen cases were reported, in the last 50 years the number has gradually increased to reach the present 782.

Neuroblastoma are pediatric tumors of neural crest origin, most often localized in adrenal glands and infrequently congenital. We report two fetal cases found at autopsy, performed at 24 and 28 weeks of gestation, respectively. The 24 week old fetus did not show any malformation; systematic histological analysis found neuroblastoma cells in both the adrenal glands and the retroperitoneal fat tissue. The 28 week old fetus was hydropic and exhibited a nodule (3 cm) in the posterior mediastinum, next to the thoracic spinal cord. This tumor responded to a neuroblastoma associated with small metastatic foci in the adrenal glands, the liver and the frontal brain cortex. The placenta was abnormally heavy and showed hemorrhagic and necrotic areas. Microscopically plugged clumps of neuroblastoma cells were found inside fetal vessels. Immunohistochemistry was employed in both cases and the cells showed immunoreactivity for NSE, NB 84, chromogranin, synaptophysin and neurofilaments, while desmin, MIC 2, and protein S-100 were negative. Congenital neuroblastomas are rare and, to our knowledge this is the thirteenth report of congenital neuroblastoma associated with placental metastasis.

We report a case of human pulmonary dirofilariasis in a 31-year-old man residing in the Aigion (Pelopennesus) Greece. The patient was hospitalized for fever of unknown cause. The chest x-ray showed a coin lesion in the left lung. Lung cancer was suspected and lobectomy was performed. Pathology reported presence of a nematode in an infarcted nodule. Its morphology enabled the diagnosis of an immature female Dirofaria repens. Twenty-two cases of human subcutaneous or subconjunctival human dirofilariasis have been reported. The present case is the first located in the lung.

A retrospective study was carried out to determine the histopathological alterations of the gastric mucosa associated with the presence of Cryptosporidium parasites in the stomach.Gastric biopsies from eight patients with AIDS and cryptosporidiosis were reviewed. Most individuals were males (7/8, mean age 34.7 years) intravenous drug users (6/8), with very low peripheral blood CD4 lymphocyte counts (150/mm3; mean 56/mm3). Endoscopic examination showed no significant mucosal abnormalities in half of the individuals; inflammation was observed in the other four individuals and was associated with erosions in two cases. The lesions observed (reactive changes, oedema, erosions, etc.) are not pathognomonic, since they are seen in most common acute and chronic gastrititis of various aetiologies (toxic, infectious, mechanical). The histological examination showed Cryptosporidium parasites in the antrum-pylorus of all examined persons, whereas only two of them had parasites in the corpus. Modifications of histological features consisted mostly of hyperplastic reactive changes of the gland epithelial and inflammation in the connective tissue of the lamina propria. No clear correlation was found between endoscopy and histological findings, whereas a close correlation between intensity of the infection and degree of histological alterations was observed.These findings suggest that, in individuals with AIDS, cryptosporidiosis and severe immunodepression, upper endoscopy with random gastric biopsies should be performed, even in the absence of endoscopically appreciable lesions. The diagnosis of gastric cryptosporidiosis has to rely on histological findings, and pathologists must be aware of the fact that Cryptosporidium parasites are mainly found in areas showing reactive hyperplasia.

Some authors divide the genus Dirofilaria into two subgenera. The subgenus Dirofilaria consists of 5 apparently valid species (D. ailure, D. freitasi, D. immitis, D. lutrae, D. spectans) and 7 species of questionable validity (D. fausti, D. indica, D. louisianensis, D. magalhaesi, D. nasuae, D. pongoi, D. spirocauda). The subgenus Nochtiella consists of 22 apparently valid species (D. acutiuscula, D. bonnei, D. cancrivori, D. corynodes, D. genettae, D. granulosa, D. incrassata, D. linstowi, D. macacae, D. macrodemos, D. magnilarvatum, D. minor, D. pagumae, D. panamensis, D. repens, D. sachsi, D. striata, D. subdermata, D. sudanensis, D. tawila, D. tenuis, D. ursi) and 8 species of questionable validity (D. aethiops, D. andersoni, D. conjunctivae, D. desportesi, D. hystrix, D. schoutedeni, D. spinosa, D. subcutanea). Actually, 10 species of the genus Dirofilaria (D. asymmetrica, D. digitala, D. kuelzii, D. ochmanni, D. pauliani, D. roemeri, D. scapiceps, D. timidi, D. uniformis, D. websteri) are attributed to other genus.

431 cone biopsy specimens referred for CIN2 and CIN3 between 1984 and 1993 were reviewed with a peculiar attention paid to the possible associated endocervical glandular changes. The following features could be demonstrated: microglandular hyperplasia (17 cases), tubal metaplasia (15 cases), mesonephric hyperplasia (10 cases), in situ adenocarcinoma (7 cases), tunnel clusters (5 cases), and ectopic endometrium (4 cases). Cervical glandular atypia could not be found. A classification of the glandular lesions in uterine cervix has been proposed for an accurate diagnostic approach of lesions who could simulate carcinomatous changes.

A case of trichocephaliasis in a 70-year-old male is described. The original diagnosis, based on radiological and endoscopic findings, was of a sessile polyp of the colon. Only when a fragment of the supposed polyp was removed at biopsy and examined histologically was it revealed as a single male specimen of whipworm.

In 3 female patients, aged 46, 50 and 74 years respectively, ovarian angiomas measuring 3, 5 and 30 mm in diameter were discovered. All the angiomas were asymptomatic. They were either associated with endometrioid carcinoma or uterine leiomyomas, or detected casually by ultrasound scan in a patient with ascites, intrahepatic nodule and increased serologic CA 125. The immunohistochemical studies failed to reveal any affinity between the vascular endothelium of our ovarian angiomas and oestrogen and progesterone receptors.

Eight new cases of Human Subcutaneous Dirofilariasis due to Dirofilaria repens in subjects aged 14 to 83 years, 5 men and 3 women, are recorded. The patients were living in Piedmont (5 cases), Tuscany (1), Friuli-Venetia Julia (1) and Apulia (1). The nematodes were immature in 6 cases (2 males and 4 females) and adults in 2 (both females). Microfilariae in the uterus of one of them were detected.

Two cases of histiocytic endometritis are reported in two 68 and 82 year-old women. One of the cases was associated with extensive endometrioid adenocarcinoma and areas of intra-myometrial histiocytic infiltration.

For some Dirofilaria spp. of zoonotic importance, such as D.immitis, D.tenuis, D.ursi, reviews of human cases were often published. For D. repens there is no published information giving a picture of the importance of the problem and of the geographical distribution of the parasite in the world. From a study of the international literature and from direct experience (our workgroup observed 75 cases in Italy) we have ascertained that the condition associated with D. repens is the most frequent and the most widely distributed in the world, of the dirofilariases of medical relevance: comprehensively 397 cases were recorded in 30 countries, exclusively in the Old World, with endemic foci in Southern and Eastern Europe, Asia Minor, Central Asia and Sri Lanka. Apparently, the most affected country is Italy with a total of 168 cases. The most common localisations are the subcutaneous (normally nodular) and the submucosal (nodular or not). The most affected areas are the head, the thoracic wall and the upper limbs. However, 15 cases with internal localisations are recorded (9 of them being pulmonary) which were always diagnosed erroneously as malignant neoplasiae. Clinical diagnosis for the other localisations was also generally wrong with the exception of the subconjunctival cases, where because of the transparency of the bulbar conjunctiva, it is possible to see the parasite directly. The correct diagnosis is usually histological, based on the identification of the nematode using the morphological characters of the species to differentiate it from the other dirofilariae or other erratic nematodes. It is possible that the zoonosis in man is more frequent than shown by the literature: many cases are not diagnosed, viz. not published, others recover spontaneously without medical intervention.

We describe a case of Acanthamoeba keratitis in a 20-year-old woman who wore disposable soft contact lenses. The diagnosis was made initially on the basis of a periodic acid-Schiff-stained corneal smear and subsequently confirmed by scanning electron microscopy and immunofluorescence. The patient was successfully treated with a combination of 0.053% polyhexamethylene biguanide and miconazole. Cytologic study and culture of corneal scrapings is relatively painless and inexpensive and may therefore be used for successful diagnosis and follow-up.

A case of subcutaneous human dirofilariasis associated with Dirofilaria repens in the arm of a 9-year-old child resident in Campobasso is described. It is the first report of the nematode in the Molise region. Blood samples taken from dogs in the same region, confirmed the presence of D. repens microfilariae in the natural reservoir, few km from the clinical case.

Eight new cases of Human Dirofilariasis in people living in Northern Italy were recorded: 3 from the province of Asti and 2 from Alessandria (Piedmont), 1 from Corsico (Miland, Lombardy) and 2 from Ravenna (Emilia-Romagna). All the patients were adults, 42 to 66 years old, 4 men and 4 women. The localization of the nematode in all the cases was subcutaneous. Signs and symptoms were always mild and consisted in the growth of a 1 to 2 cm large nodule associated with occasional localized itching and oedema, sometimes with reddening. In one case, the sting of a non-specified winged insect was recorded in the anamnesis, in the same spot where the nodule developed. In another case, the nematode came out spontaneously from the lesion. The aetiological agent was always identified as Dirofilaria repens. These 8 new cases confirm the comparatively frequent presence of Human Dirofilariasis in regions of Northern Italy, namely in the Po Valley.

A new type of portable aspirator is described. The aspirator uses as a suction device a fan that normally cools computers, in conjunction with other structural elements especially designed to cope with the greater suction power available. The device proved to be efficient, strong, light, easy to use, and silent.

Ciliated bodies, or detached ciliary tufts, are ciliated fragments of cytoplasm from columnar epithelial cells. In gynecologic cytology they have been observed in cervicovaginal smears and peritoneal washings and very occasionally in fluids from the pouch of Douglas. They occur frequently in the fluids of ovarian cysts. The authors detected ciliated bodies in 30 of 326 ovarian cyst fluid samples (9.20% of cases) taken from 27 patients aged 14-68 years. Ciliated bodies were found in the fluids from both bilateral cysts in one patient and in slides from both former and recurrent cysts in two. Surgery was performed in 14 of the cases, with histologic examination revealing 5 simple serous cysts, 3 paraovarian cysts, 3 serous papillary cystoadenofibromas, 1 serous cystoadenoma and 2 mature cystic teratomas. In the remaining cases the pertinent clinical data, including ultrasound ecography, revealed benign paraovarian and ovarian cysts. The existence of ciliated bodies in the fluids of ovarian cysts indicated the presence of ciliated columnar epithelial cells on the wall of the cysts, which would exclude cysts of follicular origin.

Several cases of Acanthamoeba encephalitis (ie, granulomatous amebic encephalitis) have been reported in patients with acquired immunodeficiency syndrome from the United States. To our knowledge, none so far has been reported from Europe, and this is the first case of amebic meningoencephalitis due to Acanthamoeba in a patient with acquired immunodeficiency syndrome from Italy. The patient was a 24-year-old, human immunodeficiency virus-positive heterosexual man with a 6-year history of intravenous drug use. He was admitted to the hospital because of severe headache, confusion, nuchal rigidity, jaundice, and ascites. He died 5 days later. At autopsy, the brain showed extensive hemorrhagic necrosis with numerous trophic and cyst forms of Acanthamoeba. The amebas were identified as Acanthamoeba divionensis by the indirect immunofluorescence test.

A case of deep keratomycosis with isolation of Rhodotorula glutinis is discussed. Keratoplasty, done immediately, prevented panophthalmitis and cured the patient. The etiology and pathogenesis of fungal keratitis is examined.

Two new cases of human subcutaneous dirofilariasis in Northern Italy are described. The first one occurred in a 56 year-old man living in Venezia Lido and was localised in the frontal region; the second one in a 52 year-old woman living in Modena and was localised in the sacrococcygeal region. Both lesions were associated with Dirofilaria repens. In the same geographical areas other cases of this zoonosis had occurred in the past.

A case of a rare lesion, i.e., congenital intramural cyst of the uterus, is reported. The diagnosis of paramesonephric cyst was suggested on the basis of histopathologic, histochemical and immunohistochemical findings. The literature is reviewed and the differential diagnosis of this lesion is discussed.

Since 1971, at the Laboratory of Parasitology, Faculty of Veterinary Medicine, University of Bologna, 30 cases of human dirofilariasis were observed out of the 101 cases reported in Italy. The causative agent was identified in nearly all the cases as Dirofilaria repens (Nematoda, Filarioidea) a parasite relatively common in the dog in Italy. 23 cases were localized in the subcutaneous tissue, 4 in the submucosa and 3 in the lungs. In the majority of the cases the diagnosis had been misinterpreted, the lesions being first seen as malignant or benign tumours or foreign-body granuloma. The parasite was histologically recognized. In 3 cases the parasite could be extracted intact from the nodule. The authors believe that human dirofilariasis is more frequent than reported by the relevant scientific literature in that many cases are likely to recover spontaneously while others would remain undetected.

A very rare case of granulomatous hepatitis in a 56-year old woman with hyperthyroidism, under long-term treatment with methimazole, is reported. Liver biopsy showed multiple non caseous granulomas in the portal triads, consisted of epithelioid and multinucleated cells, lymphocytes and isolated eosinophils. The presence of eosinophils in granulomas, could indicate an iatrogenic aethiology.

72 cases of diffuse interstitial lung diseases were observed from 1969 to 1976. Specimens removed from 47 patients were subjected to the whole spectrum of reactions. According to variation of both elastin and collagen, the following groups were outlined: group A: mycobacteriosis, farmer's lung, sarcoidosis and silicosis; group B: chronic eosinophilic pneumonia, lymphocytic interstitial pneumonia, post-tuberculous pulmonary fibrosis, and group C: X-ray pneumopathy, desquamative interstitial pneumonia, sclerodermic pneumopathy and chronic pulmonary fibrosis (primary chronic fibroadenomyosis). Each of these groups presents a close relationship between histochemical, radiological, clinical and functional findings.

Efficacy of local treatment of neoplastic pleural effusions may be related to the administered drugs, as judged by our series of 225 patients. The evaluation of the local improvement – which did not interfere with the evolution of the primary cancer – showed good (45.9%) or satisfactory (48.6%) results in a series of 148 patients treated with peptichemio. This local improvement was practically devoid of any adverse side-effect even when the treatment was particularly prolonged. This survey deals with 15 years of therapeutical experience concerned with neoplastic pleural effusions from malignant epithelial tumours

A case of pulmonary sarcoidosis involving the pleura and complicated by spontaneous hydropneumothorax is reported. Diagnosis is made by cytological features of pleural effusion and confirmed by mediastinal biopsy. The rare occurrence of this clinical situation must be diagnosed because of the important therapeutic implications, but in any event it indicates the severity of granulomatous disease.

42 cervico-vaginal out of 20,000 smears were singled out with extraneous structures of vegetable kind. Botanic analysis showed fragments of tracheae, fibres, etc., and mainly many pollen grains. The reports, accompanied by a set of pictures, are showed. Some hypotheses are presented concerning their origin. Some suggestions are proposed in order to reduce this kind of contamination which, mainly because of pollens, may lead to erroneous diagnoses.

The AA., having already illustrate the cytohistological characteristics of regenerative gastritis of the peptic ulcer, propose some differential cytological criteria with regard serious chronic atrophic gastritis and differentiated adenocarcinoma. The AA. conclude, also as result of reviewing their survey (621 cases) that the perfect knowledge of such criteria that any dubious cytological diagnosis and mistaken positives can be reduced to accettable terms.

A case of Hodgkin's disease complicated by severe Strongyloides stercoralis infection is reported. Strongyloides is an opportunistic parasite that can produce particularly dangerous clinical pictures by autoinfestation in patients with impaired immunity. The appearance of aspecific gastrointestinal symptoms in such patients should trigger careful examination to discover the presence of parasites as well as the more common pathogenic bacteria. reduced among the elderly.

The presence of E. gregorii, a species recently identified by Hugot in France in man, is signaled by the authors in Italy and in the Central African Republic. The diagnosis was based on the differential morphological characters reported by Hugot and Tourte-Schaefer in 1985.

The AA. present a new endoscopic method of gastrooesophageal cytology sampling through needle aspiration and results obtained in 90 cases. The AA. believe that this method offers undoubted advantages with regard to brushing in cases of ulcerate and necrotizing neoplasia and in those with submucous beginnings.