Fundic gland polyps and gynecological malignancies.
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Biomedical subjects
Publications and source records attributed to L Ambrosiani.
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AIMS: We report about two cases of thyroid metastases, with neoplastic thrombosis of the jugular vein, originating from a renal clear cell carcinoma and arising respectively 5 and 18 years after the original nephrectomies. MAIN RESULTS AND CONCLUSIONS: The first patient had also a synchronous transitional cell carcinoma of the bladder and a poorly differentiated prostatic adenocarcinoma, further complicating the location of the primary sources of the metastases. The metastases of the first case were firstly diagnosed by mean of fine needle aspiration biopsy, and subsequently histologically confirmed. Histochemical (diffuse PAS-positive cytoplasms) and immunohistochemical stains (wide spectrum cytokeratins low molecular cytokeratins+, Ck8+, CD10+, Vimentin+, Ck20-, Ck7-, Ck19-, PSA-, thyreoglobulin-, TTF-) performed both on cytologic and histological material helped to define the metastases as oriinating from the renal clear cell carcinoma. For the first patient, the other two possible primary sources were ruled out and a possible primary thyroid tumor with clear cell change was also excluded for both patients.
The Authors report a rare case of bladder diverticulum with radiological findings compatible with infiltrating bladder cancer and left ureterohydronephrosis. The definitive diagnosis was possible only after surgical intervention with mass removal and histological examination that resulted compatible with bladder diverticulum producing an inflammatory pseudotumor of the wall.
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Fundic gland polyps (FGPs) are tiny multiple sessile polyps of the acid-secreting gastric mucosa. They have been described both in a sporadic form, mainly in middle-aged females, and in a syndromic form, associated with familial adenomatous polyposis (FAP)-Gardner's syndrome and attenuated variants (AFAP). They share the same histology, characterised by superficial and deep cystic dilatations, shortened gastric pits, with an inconspicuous lamina propria. They have been for a long time described as innocuous lesions, but some recent reports have shown that FGPs may harbour dysplastic foci and ultimately (particularly syndromic polyps) gastric cancer. Factors influencing their genesis are unknown. A circulating factor in FAP patients has been postulated and a role of female hormones has been suggested for sporadic FGPs. Whereas patients with sporadic FGPs have normal basal acid output, normal fast serum levels of gastrin and pepsinogen I, the role of gastrin seems crucial for the development of cystic changes in flat body-fundus mucosa, and for the appearance of FGPs in patients with Zollinger-Ellison syndrome. A role of H. pylori induced gastritis has been excluded. Actually, patients with both sporadic and syndromic FGPs appear consistently free from H. pylori colonisation, again for an unknown factor(s). Some recent reports have claimed a role for omeprazole in the genesis of FGPs, a highly controversial issue. Ultimately, the nature of FGPs is still debated: some have interpreted them as hamartomatous lesions, others as a peculiar form of hyperplastic polyp.
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Explore the source record for details and available documents.
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A case of clear cell renal carcinoma metastatic to the thyroid 5 years after surgical removal of the primary tumor is presented. The differential diagnosis related to cyto-histologic findings, the uncommon occurrence and the unpredictable behaviour of clear cell renal carcinoma are discussed.
The angiomyolipoma is a rare tumor of the kidney with benign clinical evolution which can be found in more than half of the female patients with tuberous sclerosis. An uncommon case of renal angiomyolipoma with extracapsular extension, inter-aortocaval lymph node involvement and pulmonary lymphangiomyomatosis with a clinical history of spontaneous recurrent pneumothorax but without the neurological signs of the tuberous sclerosis, is described. The natural history of this disease which has various clinical forms of presentations is still unclear. The role of the lymph-node dissection in the surgical treatment of this tumor is discussed.
The Authors describe a case of intranodal myofibroblastoma presenting in the submandibular region as a firm, indolent and freely mobile rounded nodule of about 3 cm. in diameter. The nature of this uncommon benign lesion is discussed. The observed histological features are partly different from the cases originally described. A proliferation of moderately pleomorphic spindle cells, which are vimentin and muscle specific actin positive, occupies a large part of a lymph node, sharply separated from the normal tissue. The so called "amianthoid fibres" are however absent and the inflammatory cells are almost exclusively eosinophils, mainly localized at the border between the lesion and the residual lymph node. Some spindle cells also show an unexplained positivity for the S-100 protein. In addition, extranodal extension of inflammation with few spindle cells is present. Such a complex picture has many features in common with the inflammatory pseudotumor of lymph node, another benign cause of lymphadenopathy. For this reason, the Authors suggest the possibility that myofibroblastoma is not a true neoplasm, but, together with the inflammatory pseudotumor, a peculiar type or a different stage of an abnormal lymph node reactivity.
The authors describe a case of undifferentiated rhabdomyosarcoma from unknown primary site, presenting as an acute hematologic malignancy with generalized lymphadenopathy, extensive bone marrow involvement and clinical and laboratory features of disseminated intravascular coagulation. Such a peculiar behaviour is known for rhabdomyosarcoma but is rare and can be a serious diagnostic problem for the clinician and the pathologist. The importance of a large spectrum immunohistochemistry as first diagnostic approach to any undifferentiated small-cell malignant tumor is stressed, together with the knowledge of the different immunoreactivity patterns. Desmin, MS-actin and myoglobin are the most reliable markers of this type of myogenic sarcoma.
A series of 60 gastric endocrine tumors comprised 44 body-fundus argyrophil carcinoids, of which 23 arose in a background of hypergastrinemia and type A chronic atrophic gastritis (A-CAG), mainly with histologic patterns suggestive of an autoimmune process. Only 22 percent (compared with 19 percent of 58 tumor-free A-CAG cases) of 36 carcinoids and 21 percent of 19 A-CAG carcinoids investigated had Helicobacter pylori (HP) colonization, against 50 percent of 14 CAG-associated neuroendocrine carcinomas or mixed endocrine-exocrine tumors, 84 percent of 150 cases with early gastric cancer (p < 0.001 versus carcinoids), mostly with B- or AB-type CAG, 76 percent of 97 tumor-free AB-CAG, and 95 percent of 151 tumor-free B-CAG cases. Secondary hypergastrinemia and local mechanisms activated by chronic autoimmune gastritis are among factors involved in the pathogenesis of relatively indolent CAG-associated carcinoids, whereas active HP gastritis in cooperation with environmental carcinogens may likely cause more severe epithelial transformation, leading to ordinary cancer and, possibly, to neuroendocrine carcinomas or mixed endocrine-exocrine tumors.