Search

Background and Objectives Recent studies reported the feasibility of intraoperative lymphatic mapping in women with endometrial cancer but none of these studies compared the sentinel lymph nodes (SLNs) detection rates obtainable through laparoscopy or laparotomy. The purpose of this study was to address this issue. Methods Thirty-four patients with clinical stage I–II endometrial cancer were enrolled in this prospective comparative trial. Four milliliters of Patent Blue Violet were injected into the cervix after the induction of general anesthesia. The assessment of SLNs was done in 17 patients through laparoscopy and in 17 patients through laparotomy as first step of systematic pelvic lymphadenectomy. Both SLNs and non-SLNs were evaluated for micrometastases. Results The SLNs detection rate was significantly higher (82%) for laparoscopy than for laparotomy (41%; P = 0.008). Pelvic lymph node metastases were present in 6 out of 34 patients (18%) but only 3 (50%) of these patients were correctly identified. Conclusions SLNs detection rate is significantly higher through laparoscopy than through laparotomy after vital dye pericervical injection but intraoperative vital dye pericervical injection is not reliable as part of standard care for predicting lymphatic spread in women with early stage endometrial cancer. J. Surg. Oncol. 2010; 101:408–412. © 2010 Wiley-Liss, Inc.

A case of hyalinizing clear cell carcinoma (HCCC) of the minor salivary glands of the oral cavity is reported. A 52- year-old woman presented with a growing mass at the base of the tongue. The patient underwent complete resection of the tumour. The histological picture was characterized by trabeculae or solid nests of proliferating cells with a clear cytoplasm, surrounded by a hyalinizing stroma. Tumour cells were immunoreactive for Cytokeratins 5, 6, 7, 8, 14, 17 and 18. No reactivity was observed for cytokeratin 20, vimentin, S- 100 protein, smooth-muscle actin, muscle-specific actin, and calponin. These findings confirmed the diagnosis of HCCC of minor salivary glands of the oral cavity. The clinical presentation, the immunohistochemical pattern and the role of cytokeratins in the differential diagnosis of HCCC are discussed with a review of the literature.

We report the prevalence of thyroarytenoid (TA) muscle invasion in 109 consecutive patients with T1 glottic carcinoma submitted to endoscopic laser cordectomy between February 1997 and January 2006, in order to evaluate if routine resection of the TA is necessary. A total of 109 patients staged as T1 underwent endoscopic treatment with carbon dioxide laser (CO(2)), 36 cases were treated with type I or II cordectomies, and 73 patients underwent type III, IV or V cordectomies, with resection of all or part of the TA. Over a total of 109 patients, 6 (5.5%) cases staged as pT1 showed TA invasion. The endoscopic treatment of T1 glottic cancer should be as conservative as possible in terms of TA resection, since muscle invasion is rare. In many cases, type III and IV cordectomies can be regarded as excessive treatment. Muscle invasion found histologically after type II cordectomy can be managed by further excision.

Kaposi’s sarcoma of an intraparotid lymph node is extremely rare in non-immunocompromised human immuno-1 deficiency virus (HIV)-negative patients. We report a case of a left parotid mass as an early sign of Kaposi’s sarcoma-associated human herpesvirus 8 (HHV-8) infection in a 57-year-old patient. After subtotal parotidectomy and histopathological diagnosis of lymph node localization of Kaposi’s sarcoma, an accurate dermatological investigation revealed a solitary small lesion in the left foot. Chemotherapy with five cycles of vincristine gave a temporary response of the cutaneous lesion. Seven months later, a few small, firm, purplish-red lesions appeared in different areas of the body, but no adjuvant treatment was accepted by the patient since the lesions occasionally disappeared or remained stable in size. At four years follow-up, there has been no recurrence in the parotid region, and the patient is alive with cutaneous disease but in good general health. The problems related to the diagnosis, the management strategy of such a rare condition and the prognosis are also discussed.

Background/Aims: Determination of hepatic copper concentration is important in the diagnosis of Wilson's disease. We studied copper distribution in the cirrhotic liver of a patient who died of Wilson's disease. Methods: A liver slice extending from the left to the right lobe was divided into 38 samples. Each sample was analyzed for copper content by Induced Coupled Plasma Atomic Emission Spectroscopy. Results: The mean copper concentration in the liver was 1370 μg/g dt. A striking variability, up to 2–3-fold, in copper levels was observed between the samples: the copper concentration ranged from 880 to 2100 μg/g dt, with significant differences even between adjacent samples. Lobar differences were also observed, with a tendency of the right lobe to accumulate more copper than the left lobe. Histochemical analyses confirmed the uneven distribution of copper even at the acinar level. Copper was mainly stored in periportal hepatocytes (zone 1) and at the periphery of the regenerating nodules. Moreover, we observed some nodules with the majority of hepatocytes full of copper granules, adjacent to areas of parenchyma negative for copper stains. Conclusions: Our data show that: 1) copper is unevenly distributed in Wilson's disease in the cirrhotic stage; 2) a lobar pattern of copper distribution is evident in this case, characterized by a higher copper concentration in the right lobe; 3) the observed lobal pattern is different from that described in the newborn liver, characterized by a higher copper content in the left compartment of the liver; 4) copper content determined in a small liver sample cannot be considered as absolutely representative of the mean hepatic copper concentration. From a practical point of view, our data show that sampling variability deserves more consideration in the diagnosis and in the monitoring of Wilson's disease. The use of hepatic copper concentration in monitoring the efficacy of the copper-chelating therapy may be unreliable, particularly in the cirrhotic stage, because of the patchy distribution of copper, as demonstrated in this study.

The diagnosis rate of deep pelvic endometriosis is increasing. Endometrial stromal sarcoma (ESS) is a rare neoplasm. Extragenital ESS is an extremely uncommon event. Very few cases of extragenital ESS have been reported to date. The diagnosis of this entity is very difficult in some instances. Knowledge about its management is also limited. In this paper, we review the current literature on the clinical management, histology, immunohistochemistry, treatment and outcome of ESS arising in pelvic endometriosis.

Review on Vulva and Vagina tumors: an overview, with data on clinics, and the genes involved.

Note Anatomically, uterine neoplasms may be localized at the corpus, isthmus (the transition between the endocervix and uterine corpus) and cervix. The fallopian tubes and uterine ligaments may also undergo tumour tranformation. This overview will focus on uterine cervix and corpus tumours, including benign, pre-malignant and malignant lesions. They may affect the endometrium, muscles or other supporting tissue. Uterine tumours may be histologically typed according to several classification systems. Those used most frequently are based on the WHO (World Health Organization) International Histological Classification of Tumours and on the ISGYP (International Society of Gynecological Pathologists). The most widely-accepted staging system is the FIGO (International Federation of Gynecology and Obstetrics) one.

Objectives To describe the clinical history and ultrasound findings in patients with ovarian dysgerminoma. Methods This was a retrospective study of patients with a histological diagnosis of ovarian dysgerminoma who had undergone preoperative ultrasound examination. The patients were identified from the databases of 11 ultrasound centers. The tumors were described by the principal investigator at each contributing center on the basis of ultrasound images, ultrasound reports and research protocols (when applicable) using the terms and definitions of the International Ovarian Tumor Analysis (IOTA) group. In addition, three authors reviewed all available electronic ultrasound images (gray-scale images and color/power Doppler images were available for 18 patients and 14 patients, respectively) and described them using subjective evaluation of gray-scale and color Doppler ultrasound findings (here called pattern recognition). Results Twenty-one patients with ovarian dysgerminoma were identified (including one woman with bilateral masses). Twenty patients had a primary ovarian dysgerminoma (including the one with bilateral masses) and one patient had a recurrence of dysgerminoma in her retained ovary. One of the 21 patients was pregnant. All tumors except one were pure dysgerminomas, one being a mixed germinal cell tumor with 30% dysgerminoma component. Median age was 20 (range, 16-31) years. Information on clinical symptoms was available for 18 patients. In four patients, the tumor was detected incidentally, whereas 14 patients presented with one or more of the following symptoms: acute pain (n = 4), chronic pain (n = 8), bloating (n = 8), menstrual disorders (n = 5) and infertility problems (n = 1). One (5%) patient had ascites. Using the IOTA terms and definitions, all but one dysgerminoma were moderately (43%) or very well (50%) vascularized solid tumors. One tumor was multilocular-solid. According to pattern recognition, most dysgerminomas were highly vascularized, purely solid tumors with heterogeneous internal echogenicity divided into several lobules, had a smooth and sometimes lobulated contour and were well-defined relative to the surrounding organs. Conclusion The ultrasound finding of a highly vascularized, large, solid, lobulated adnexal mass with irregular internal echogenicity in a woman 20-30 years old should raise the suspicion of ovarian dysgerminoma. Copyright (C) 2011 ISUOG. Published by John Wiley & Sons, Ltd. (Less)

Recent studies reported the feasibility of intraoperative lymphatic mapping in women with endometrial cancer but none of these studies compared the sentinel lymph nodes (SLNs) detection rates obtainable through laparoscopy or laparotomy. The purpose of this study was to address this issue.Thirty-four patients with clinical stage I-II endometrial cancer were enrolled in this prospective comparative trial. Four milliliters of Patent Blue Violet were injected into the cervix after the induction of general anesthesia. The assessment of SLNs was done in 17 patients through laparoscopy and in 17 patients through laparotomy as first step of systematic pelvic lymphadenectomy. Both SLNs and non-SLNs were evaluated for micrometastases.The SLNs detection rate was significantly higher (82%) for laparoscopy than for laparotomy (41%; P = 0.008). Pelvic lymph node metastases were present in 6 out of 34 patients (18%) but only 3 (50%) of these patients were correctly identified.SLNs detection rate is significantly higher through laparoscopy than through laparotomy after vital dye pericervical injection but intraoperative vital dye pericervical injection is not reliable as part of standard care for predicting lymphatic spread in women with early stage endometrial cancer.

Schwannomas of the vagus nerve are very rare and the differential diagnosis is extremely difficult. They are very often asymptomatic and imaging techniques are helpful, but fine needle biopsy is often inconclusive. Total resection is the treatment of choice.

Objective:Carcinoma cuniculatum is a rare variant of low-grade squamous cell carcinoma. We report the second case of carcinoma cuniculatum of the larynx in the literature.Method:Case report and review of the world literature concerning carcinoma cuniculatum of the larynx and upper aerodigestive tract.Results:A histologically proven carcinoma cuniculatum of the larynx is reported in a 72-year-old man. The patient underwent a supracricoid laryngectomy with crico-hyoidopexy, and was free of disease at 70 months after surgery. We emphasise the clinical presentation, histology and therapeutic approach of this rare tumour.Conclusion:To our knowledge this is the second report in the world literature of carcinoma cuniculatum of the larynx. Carcinoma cuniculatum of the larynx must be considered as a distinct ‘clinicopathological entity’ and close cooperation between the clinician and the pathologist is essential for the correct diagnosis of these tumour as regards to the correct classification and therapy.

Background/Aims: Determination of hepatic iron concentration is crucial in the evaluation of iron-storage disease. Iron content in normally determined in a part of a needle liver biopsy and the value obtained is considered to be representative of the iron concentration in the whole liver. To evaluate the reliability of this procedure, we studied iron distribution in the liver of two beta-thalassemic patients. Since the transport of intracellular iron is mediated by phosphates, we also studied the hepatic phosphorus distribution. Methods: At autopsy, a liver slice extending from the left to the right lobe was divided into 51 and 49 samples, respectively. Each specimen was subdivided into two parts: oen of them was paraffin-embedded and utilized for the histochemical detection of iron: the second part was analyzed for iron and phosphorus content by induced coupled plasma atomic emission spectroscopy. Results: The histological picture of both livers was characterized by portal and periportal fibrosis associated with iron storage of different degree, without cirrhosis. The mean iron concentration of the liver was 20 631±4903 μg per g of dry tissue (μg/g dt) and 13 901±1976 μg/g dt, respectively. A striking variability in iron content between samples was also found: iron concentration ranged from 11 537 to 32 347 μ/g dt in the first case and from 6257 to 16 493 in the second case. We even observed regional differences in iron concentration, with a preferential peripheral accumulation in both cases and a tendency of the left compartment of the liver to accumulate more iron in the first case. Histochemical analyses confirmed the uneven iron distribution even at the acinar level, showing iron mainly being stored in hepatocytes and Kupffer cells of zone 1 of the acinus, with decreasing amounts of iron in zones 2 and 3. The mean hepatic phosphorus concentration was 6662± 1300 μ/g dt (range: 4348–9947) and 7502±986 μ/g dt (range: 5844–90 282), respectively. The regional distribution of phosphorus was similar to that observed for iron. A strict correlation between iron and phosphorus content was also observed. Conclusions: Our data show that: 1) iron and phosphorus are unevenly distributed in the beta-thalassemic liver, even in the non-cirrhotic stages; 2) a regional pattern of iron and phosphorus distribution is evident, characterized by higher concentrations at the periphery of the liver; 3) the observed uneven distribution of iron and phosphorus implies that their content determined in a small liver sample cannot be considered as absolutely representative of the mean hepatic iron concentration. Therefore, iron concentrations determined in a part of a needle liver biopsy should be interpreted with caution in monitoring the efficacy of the iron-chelating therapy in beta-thalassemic patients.

Eighteen copper intrauterine devices (IUDs), removed after 25 months of use, were examined to evaluate cells adhering to them (IAC). By means of monoclonal antibodies, the antigenic phenotype of IAC was studied, along with some IAC cytochemical properties. Sixty percent of IAC were identified as granulocytes based on morphological, cytochemical, and antigenic characteristics. A small proportion of IAC were shaped like large foreign-body macrophages, with multiple picnotic nuclei, and diffused alpha naphtyl acetate esterase (ANAE) activity. Some IAC identified as macrophages from a morphological view point also showed dipeptidil-diaminopeptidase IV (DAPIV) reactivity, previously described only in T-helper lymphocytes. Most IAC identified as macrophages reacted with the monoclonal antibodies OKM1 and HLA-DR, and showed ANAE activity in the form of small multiple granules. The hypothesis that IUD-adhering macrophages with an ANAE +, DAPIV+, OKM1 +, and HLA-DR + phenotype could play a role in the inactivation of spermatozoa can be proposed.

The influence of gamma-amino-beta-hydroxy butyric acid (GABOB) treatment on pituitary function has been investigated in this study. Different doses (50 x 100 mg) of GABOB were iv injected into three and six normal women, respectively. PRL and GH plasma levels were measured before and after the injection. The treatment with 150 mg GABOB, performed in another two normal women, was interrupted because of side-effects (loss of consciousness etc.) due to the treatment. The treatment with 50 mg GABOB did not induce significant variations of the two hormones; however, significant increases of PRL (P less than 0.05) and GH (P less than 0.01) plasma levels were observed after injection with 100 mg GABOB. The present data suggest that gamma-amino butyric acid (GABA) itself of GABAergic drugs might play an important role in the control of hypothalamic-pituitary function.

Background Nasal lobular capillary hemangioma (LCH) is a benign lesion of unknown etiology that must be included in the differential diagnosis of vascular lesions. Based on a large cohort of LCH patients, we retrospectively analyzed the clinical presentation, histological and radiological findings, and the treatment strategy. Methods Clinical records of 40 patients affected by LCH, treated in a 10-year period at two university hospitals, were reviewed. Data concerning symptoms, possible etiologic factors, endoscopic findings, imaging studies, and treatment were collected. Results Previous nasal trauma and pregnancy were identified as possible causes in six (15%) and two (5%) patients, respectively. The main symptoms were unilateral epistaxis (95%) and nasal obstruction (35%). Lesions ranged in size from 1 to 8 cm and mainly involved the nasal septum (45%) and the nasal vestibule (17.5%). In the four (10%) patients with a large lesion, radiological evaluation was helpful not only in assessing the extent, but also in suggesting the possible nature of the lesion. All patients underwent endoscopic resection under local (72.5%) or general (27.5%) anesthesia. At mean follow-up time of 53 months, no recurrence has been observed. Conclusion To the best of our knowledge, this is the largest series of patients with nasal LCH. When the mass is considerable in size, differentiation from other hypervascularized lesions may be intriguing. Under these circumstances, information obtained with imaging may sometimes suggest a correct diagnosis without resorting to biopsy. Endoscopic surgery is the treatment of choice even for large lesions, that do not require preoperative embolization.

This study aimed to describe an unusual case of metachronous isolated inguinal lymph nodes metastasis from sigmoid carcinoma. A 62-year-old man was referred to our department because of an obstructing sigmoid carcinoma. Colonoscopy showed the obstructing lesion at 30 cm from the anal verge and abdominal CT revealed a sigmoid lesion infiltrating the left lateral abdominal wall. The patient underwent a colonic resection extended to the abdominal wall. Histology showed an adenocarcinoma of the colon infiltrating the abdominal wall with iuxtacolic nodal involvement. Thirty three months after surgery abdominal CT and PET scan revealed a metastatic left inguinal lymph node involvement. The metastatic lymph node was found strictly adherent to the left iliac-femoral artery and encompassing the origin of the left inferior epigastric artery. Histology showed a metachronous nodal metastasis from colonic adenocarcinoma. Despite metastastic involvement of inguinal lymph node from rectal cancer is a rare but well known clinical entity, to the best of our knowledge, this is the first report of inguinal metastasis from a carcinoma of the left colon. Literature review shows only three other similar reported cases: two cases of inguinal metastasis secondary to adenocarcinoma of the cecum and one case of axillary metastasis from left colonic carcinoma. A metastatic pathway through superficial abdominal wall lymphatic vessels could be possible through the route along the left inferior epigastric artery. The solitary inguinal nodal involvement from rectal carcinoma could have a more favorable prognosis. In the case of nodal metastasis to the body surface lymph nodes from colonic carcinoma, following the small number of such cases reported in the literature, no definitive conclusions can be drawn.