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In this chapter we give some hint regarding the interpretation of aspirates taken from epithelial proiferative lesions, trying to underline the differences between the main categories in order to guide patients to the best management

Brown bowel syndrome (BBS) is an extremely unusual condition characterized by an orange-brown discoloration of the bowel and intestinal motility disorders secondary to fat-soluble vitamin deficiency and malabsorption from many different causes. We present the case of a middle-aged woman suffering for years of chronic constipation with recurrent intestinal subocclusion, who was diagnosed BBS on surgical biopsy material. Nutritional supplementary treatment was tried, but her symptoms did not improve, and a decision was finally made in favor of a surgical approach. After subtotal colectomy and continual vitamin nutritional supplementation, she has now regular transit without the use of laxatives. BBS is a rare complication of long-term malabsorption manifesting as intestinal motility disorders, which can lead to severe complications. This condition is only partially responsive to vitamin supplementation, and most cases require surgery.

Breast Cythopathology is a field characterized by pratically and diagnostic efficacy. This book focuses mainly on morphology, with helpful hints for recognizing benign lesions and the main features of malignancy. It reviews specific features of various lesions and the consequences of diagnosis for the management of the patient. Each chapter contains high-quality cytology omages accompanying the descriptions, including comparison images to distinguish the most importsnt morphological features and to help in the differential diagnosis. Fine needle aspiration cytology (FNAC) sampling and preparation technique ,fixation, staining, and principles of its interpretation are covered. Immunohistochemistry and ancillary techniques are outlined, as well as the main clinical and radiological features of breast lesions, and cytological diagnostics of axillary lymph nodes. This publication will be of great use to medical pracctitioners in their first approach to breast cyttopathology, as well as to pathologists and cytotechnicians with little to moderate experience in the field.

Objective. Ductal carcinoma in situ (DCIS) of the breast is becoming more and more frequent in women after the introduction of breast screening programmes. Once the diagnosis is confirmed on the surgical specimen, its prognosis is excellent, but still some tumours recur as in situ or even invasive neoplasms in the same or contralateral breast. Neoductgenesis (NGD), defined by László Tabár and Tibor Tot as the presence of “casting type” calcifications on mammography, an abnormal number of ducts, periductal desmoplastic reaction and lymphocytic infiltrate, has been proposed as a marker of aggressiveness in “early” breast carcinoma (1 2). We analysed this phenomenon in pure DCIS by correlating its presence with clinical and instrumental findings, morphological and immunohistochemical features, and with patients’ prognosis. Materials and Methods. We selected 199 cases of breast DCIS undergone surgery between 2004 and 2016, available at the Unit of Pathology of the Academic Hospital of Trieste, and performed a re-evaluation of the histological slides in order to define the presence or absence of NDG, based on the morphological features previously described2. Furthermore, a subgroup of 64 cases underwent radiological review by two expert radiologists (AF, MT) in order to re-classify the mammographic findings according to specific types of calcifications1. The correlation between morphological NDG, casting type calcifications and prognostic markers of breast DCIS, such as extension, grade and expression of hormonal receptors and HER2-neu, as well as with disease recurrence, was evaluated through Chi-Square independence test or Fisher test as appropriate. Results. NDG was identified in 33 cases (16.6%) and was found to be positively associated with the larger size of lesions on mammography (p=0.008), histological high grade (p

Breast Fine Needle Aspiration Cytology (FNAC) represents first choice diagnostic tool to determine mammographic lesions and clinically palpable breast nodules. FNAC is affected anyway by a certain degree of subjectiveness, that is more evident with the so- called “grey zone” cases (the ones not clearly benign or not clearly malignant) and when there are some doubts about material adequacy. These situations may create some misunderstandings between clinicians and pathologists with possible over or undertreatment for patients. The need for clear communication is extremely important, but it becomes a priority in senology because of the multidisciplinary aspects of the field. For this reasons a breast cytology reporting system has been proposed since 1993 within a U.K. mammographic breast screening programme. From our experience we think only a cytological exam with well demonstrated and well documented quality which satisfies those criteria suggested by guidelines will be able to play a key role in patients’ clinical management. It will allow reducing as much as possible diagnostic biopsies on benign lesions and frozen sections to confirm malignant lesions.We believe that a good quality cytology can provide an important and relevant contribution to define breast lesions’ nature without using other invasive procedures and to obtain in most cases good material for subsequent molecular investigations. Cytological approach to breast lesions was also validated in Breast Unit of Trieste during EUSOMA certification visit.

Undifferentiated embryonal sarcoma of the liver is a malignancy with poor prognosis observed more frequently in children between 6 and 10 years old and very rarely found in adults. We present a case of embryonal sarcoma of the liver in a 60-year-old woman without significant medical history who presented to our attention with constitutional symptoms. Preoperative assessments did not show alterations in blood chemistry or tumor markers. Imaging studies showed a huge mass lying in the right abdominal quadrants, strictly adherent to the liver. The tumor was partially cystic with a thickened wall, sporadic contrast enhancement, and solid component. The patient underwent excision of the mass with associated liver bisegmentectomy S5-S6. Postoperative course was uneventful. The definitive histological diagnosis revealed the presence of embryonal sarcoma of the liver. We describe the clinical, histopathological, and therapeutic options adopted in the multimodal treatment of this disease.

Fine needle aspiration (FNA) has traditionally been regarded as the simplest, less invasive and less expensive diagnostic procedure for the definition of breast lesions. In expert hands, it allows obtaining an accurate diagnosis in most breast lesions. The introduction of widespread mammographic screeningprogrammes and the consequent detection of a large number of small, non-palpable lesions have increasingly brought to the routine use of other minimally invasive biopsy methods using heavier gauge cutting needles – the so-called core biopsies (CB) and other automatic, imaging-guideddevices, such as vacuum assisted biopsies (VAB) – partially obscuring the central role of FNA. Recently, new recommendations propose to definitively abandon FNA, restricting all morphological investigations to CB.Has FNA completely lost its role as to let us to remove it from the routine diagnostic practice? In our personal experience from the breast unit of Trieste, where there systematic use of FNA is available, it is proved that this method may bring to a definitive diagnosis 2/3 of the lesions investigated. The unjustified abandonment of the technique by breast healthcare centres must be avoided, since it could only have negative repercussions on the whole preoperative diagnostics.it is necessary for the pathologists to guarantee the maintenance of their professional expertise in this field, and to transmit it to the young.

Gli indicatori relativi ai tempi di attesa sono difficili da rispettare, come recentemente evidenziato al XIII Convegno ONS 2015 . Per questo motivo è fondamentale identificare in quale momento della gestione dei carcinomi screening-detected si concentrino i ritardi e stabilirne le cause (se attribuibili alla paziente o all’organizzazione del programma o intrinseci al tipo di lesione) così da proporre mirate modifiche migliorative. Metodi: L’analisi riguarda 146 carcinomi screening-detected consecutivi (biennio 2013-2014). Sono stati misurati i tempi tra le varie fasi diagnostiche (Mammografia di I° livello, Richiamo II° livello, I° approfondimento cito/microistologico, Comunicazione diagnosi) e i tempi chirurgici (Visita chirurgica, Intervento chirurgico, Referto istologico con marcatori biologici, Visita oncologica). Per ogni fase sono stati calcolati i tempi medi/mediani rappresentati tramite box plot e giustificati gli outliers.Risultati: La latenza nella presa in carico chirurgica è legato alla complessità degli esami preoperatori (3) (tempo mediano tra richiamo al II° livello ed intervento: 53 giorni (se unico esame pre-operatorio) vs 73 (se più di un esame pre-operatorio, p