Hypopituitarism and rare dermatological diseases: an intriguing case of xanthoma disseminatum.
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Adult↗
Biomedical subjects
M Lentini
Publications and source records attributed to M Lentini.
Histological features used in the diagnosis of melanoma are frequently found in benign melanocytic naevi.
AIMS: The histological features used in the diagnosis of melanoma may be present in benign naevi, but quantitative data are not available. The aim of this study was to establish the real prevalence of such features in naevi. METHODS: Ten dermatopathologists, from nine Italian institutions, studied a series of naevi. Eleven histological parameters currently used in melanoma diagnosis were analysed: asymmetry, poor circumscription, predominance of single melanocytes, irregular confluent nests, suprabasal melanocytes, hair follicle involvement, absence of maturation, cytological atypia, dermal lymphocytic infiltrate, mitoses, and necrosis. RESULTS: Ninety one naevi were examined: 22 junctional, 59 compound, and 10 intradermal. None of the studied parameters was seen in 22 of the benign naevi studied. One or more investigated features were found in 69 naevi. Poor circumscription was found in 49 cases, single melanocytic predominating in 42, asymmetry in 41, irregular confluent nests in 16, cytological atypia in 14, suprabasal melanocytes in seven, and hair follicle involvement in seven; absence of maturation, mitoses and necrosis were not found. CONCLUSIONS: The histological features used for the histological diagnosis of melanoma are often present in benign melanocytic naevi. This suggests a critical, non-mechanical use of them in melanoma diagnosis.
Adult↗
Interobserver reproducibility of histological features in cutaneous malignant melanoma.
AIMS: To assess the interobserver reproducibility of certain histological features proposed for the diagnosis of melanoma. METHODS: In a series of melanomas, 13 histological parameters were analysed: dimension > 6 mm, asymmetry, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, cytological atypia, mitoses, dermal lymphocytic infiltrate, and necrosis. RESULTS: The agreement (reproducibility) between the nine observers was excellent (kappa > 0.75) for 10 of the 13 examined features (dimension > 6 mm, poor circumscription, irregular confluent nests, single melanocytes predominating, absence of maturation, suprabasal melanocytes, asymmetrical melanin, melanin in deep cells, mitoses, and necrosis). The agreement for asymmetry was very close to excellence (kappa = 0.74), and that for cytological atypia (kappa = 0.65) and dermal lymphocytic infiltrate (kappa = 0.47) was slightly lower, but in the fair to good agreement range. The kappa values obtained by comparison with the majority diagnosis were generally high (> or = 0.85); the mean value of kappa was lower (0.70) for only one parameter (dermal lymphocytic infiltrate). CONCLUSIONS: The parameters investigated showed an overall good reproducibility.
Humans↗
Uterine pathologies in patients undergoing tamoxifen therapy for breast cancer: ultrasonographic, hysteroscopic and histological findings.
PURPOSE OF INVESTIGATION: To evaluate endometrial abnormalities by ultrasonography, hysteroscopy and biopsy in postmenopausal patients treated with tamoxifen as adjuvant therapy for breast cancer. METHODS: The study was carried out on 113 patients who underwent vaginal ultrasonography, hysteroscopy and endometrial biopsy. RESULTS: There was a significative relation between ultrasonographic and hysteroscopic features (p < 0.001); 58 polyps were diagnosed at hysteroscopy, although 35 were not found at ultrasonography. A significant relation between ultrasonographic and histological findings was also documented (p < 0.005). A significant relation between histological findings and symptomatology was found (p < 0.05), although pathologies were also present in asymptomatic women. CONCLUSIONS: These results show that long-term tamoxifen therapy in breast cancer patients is associated with a higher incidence of uterine pathology. No significant relation has been documented between duration of treatment and grade of endometrial lesion (p > 0.05). Ultrasonography alone is useful in asymptomatic patients because it selects patients with increased endometrial thickness who should undergo hysteroscopy. Hysteroscopy is more accurate in detecting polyps, hyperplastic and neoplastic changes. Asymptomatic tamoxifen treated women should be evaluated as symptomatic patients.
Adult↗
Melanocytic nevi of the breast: a histologic case-control study.
BACKGROUND: Melanocytic nevi in the genital, acral, and flexural sites often display clinical and histologic features that may simulate melanoma. We verified whether this is the case also for nevi of the breast. METHODS: Eleven dermatopathologists, from nine Italian Institutions, collected the specimens of melanocytic lesions from the breast and other body sites, excluding the acral, genital, and flexural areas, as controls. Cases and controls were matched for sex and age. All nevi were observed 'blindly' and simultaneously by all participants. For each lesion, 10 histological parameters were analyzed: asymmetry, absence of lateral demarcation of melanocytes, lentiginous proliferation, nested and dyshesive pattern, intraepidermal melanocytes above the basal layer, involvement of the hair follicle, absence of maturation of dermal melanocytes, melanocytic atypia, fibroplasia of the papillary dermis, and lymphocytic dermal infiltrate. Each parameter was scored 2 when present and 1 when absent or not valuable. A total score was calculated for each lesion. Results were statistically analyzed by the chi-square test and the Mann-Whitney U-test. RESULTS: One hundred and one nevi came from the breast area and 97 from elsewhere. Breast nevi exhibited significantly more atypical features than nevi from other sites. In particular, breast nevi with intraepidermal melanocytes, melanocytic atypia, and dermal fibroplasia were significantly more numerous. We did not find any sexual difference. CONCLUSIONS: To avoid undue concerns, dermatopathologists should be aware that melanocytic nevi of the breast may show a high degree of atypical features.
Adolescent↗
[Human equine type melanoma: clinicopathologic study of 4 cases].
Four cases of human "equine" melanoma are presented. Two had poor prognosis, evidenced by the presence of metastases, and one of these with a rapidly fatal outcome. Human "equine" melanoma is characterized by an expansive, compact, heavily pigmented, dermal melanocytic proliferation without epidermal involvement. The mitotic index is always low, while minute foci of necrosis are present. The differential diagnosis is discussed, outlining the overlapping of the histological features with those of the malignant blu nevus. The only difference is the possible presence in the latter of areas characteristic of either common blu nevus or cellular blu nevus. With regards to the histogenesis of human "equine" melanoma we found no elements to support a follicular sheath origin and we propose a possible perineurial origin.
Adolescent↗
Cutaneous angiosarcoma of the face.
Cutaneous angiosarcoma is a rare tumour of vascular origin, which has a poor prognosis because of its high potential for metastasis. We report the case of a 57-year-old man with an 8-month history of a progressively enlarging, asymptomatic red patch over the left periorbital region of the face, previously diagnosed as angiolupoid leishmaniasis, insect-bites, 'cellulitis' and treated with several topical antibiotic and steroid therapy, without any improvement. A skin biopsy of the lesion was performed and histological and immunohistochemical examination revealed a pattern of poorly differentiated angiosarcoma. The peculiarity of the localization at the periorbital area and the particular clinical presentation are emphasized.
Antineoplastic Combined Chemotherapy Protocols↗
Bowenoid basal cell carcinoma of the thumb: a case report and review of the literature.
Basal cell carcinoma (BCC) is the most common skin malignancy arising from cells of the basal layer of the epithelium or from the external root sheath of the hair follicle. BCC of the digit is a rare entity. The article presents one such case of bowenoid BCC of the thumb which required amputation at the MP joint.
Aged↗
Twisted ovarian fibroma with high signal intensity on T1-weighted MR image: a new sign of torsion of ovarian tumors?
Torsion of ovarian tumors is often difficult to diagnose, because of non-specific clinical, laboratory, and imaging findings. We report a case of twisted ovarian fibroma whose main characteristic was the presence of large areas of high signal intensity on both T1- and T2-weighted MR images due to the passive congestion of the mass. This previously unreported finding should be considered a sign of ovarian torsion and may facilitate prompt surgical intervention.
Female↗
Standardized AgNOR analysis in actinic keratosis.
To assess if the quantity of silver-stained nucleolar organizer region (AgNOR) proteins predicts the behavior of actinic keratosis (AK), we performed a standardized AgNOR analysis on 51 cases of AK; in addition, 10 cases of squamous cell (SCC) and 10 cases of basal cell (BCC) carcinomas and 10 normal skin samples were also studied. AgNOR analysis was performed on formalin-fixed and paraffin-embedded sections according to the guidelines of the Committee on AgNOR Quantification (1995), evaluating the mean area (microm(2)) of AgNORs per nucleus (NORA). A highly significant P value (< 0.001) was found in the comparison among NORA values of normal skin (1.869 microm(2); SD + 0.332), AK (3.988 microm(2); SD + 0.914), BCC (3.044 microm(2); SD + 0.254), and SCC (5.286 microm(2); SD + 0.920). In AK, a progressive increase of mean NORA values was observed moving from Stage I (3.161 microm(2); SD + 0.600) to Stage II (3.455 microm(2); SD + 0.562), Stage III (4.360 microm(2); SD + 0.295), and Stage IV (5.168 microm(2); SD + 0.694); highly significant differences (P < 0.001) were noted when Stages I or II were compared with Stage III or Stage IV or between these latter stages. The AgNOR quantity may identify AKs with high proliferative activity and increased tendency to develop into invasive SCC.
Adult↗
[The Studer ileal bladder and the Paduan ileal bladder: comparison of 2 techniques].
Between January 1988 and December 1995 48 orthotopic detubularized and reconfigured ileal neobladder were carried out with two distinct surgical procedures in the same Hospital. 33 underwent lower urinary tract reconstruction using Studer's technique with an afferent ileal tubular isoperistaltic segment; in 15 patients the ileal substitution of the bladder was performed with Paduan ileal bladder (VIP). In any case an ileal low pressure reservoir was obtained with similar functional capacity (400 ml. at the urodynamic control), as using the same length of ileum (40 cm) for the reconstruction of the reservoir itself. In order to other functional aspects (e.g. diurnal and nocturnal continence) results were analogous if a correct rehabilitation program was observed. Significant post-voiding residual and late neobladder decompensation was prevented with adequate mictional training. Early and late complications (globally 19-24%) were evaluated: strictures of ureteroileal and ileo-urethral anastomoses were rare; an ileoureteral reflux was observed at a cystographic control in 50% of Studer group, but never clinically significant and only in 20% of VIPs. No clinically significant metabolic changes were found. Survival was satisfactory at a mean follow-up of 48 months.
Adult↗
[Twelve years of ureterorenoscopy: evolution of the technique].
In the last ten years the diagnostic and therapeutical approach to ureteral neoplasms and stones changed their feature, due to improvement of the ureteroscopy. The passage through flexible to rigid and finally semirigid ureteroscopes permitted reduction of invasiveness with higher results. The positive changes to the energy sources, in regard to cost-benefit, it was versus ballistic energy. Ureteroscopy should now be considered as a simple and safe technique, with minimal morbidity and invasiveness and also short operative times.
Cost-Benefit Analysis↗
[Comparison of free/total PSA (F/T PSA) ratio and PSA density (PSAD) in the early diagnosis of cancer of the prostate].
The identification of the immuno reactive molecular forms of PSA has permitted the identification of a correlation between Free PSA and Total PSA as the most important factor in the early diagnosis of prostate cancer. Cut-off of 0.15 ng/ml seems to be the most appropriate. The Authors consider that the use of this limit is important in the decision to carry out a prostate biopsy on the patients with PSA in the range of 4-10 ng/ml who have neither any clinical symptoms nor an abnormal transrectal ultrasound. In particular the sensitivity and the specificity of F/T PSA and the density of PSA (PSAD) have been compared at his limit of 0.15. In our study of 60 patients (of whom 22 were affected by cancer and 38 by BPH) we have noticed that 27/60 patients had a value of PSA between 4 and 10 ng/ml and negative DRE and TRUS. On the whole the F/T PSA report showed a slightly higher specificity than PSAD; in contrast PSAD showed a slightly higher sensitivity. In conclusion, to identify the early detection of this cancer both tests are required as well as a biopsy.
Humans↗
[Urinary PSA (uPSA) in the monitoring of local recurrence following radical prostatectomy].
The level of urinary PSA (PSAu) was measured for use as a marker in some clinical situations involving prostate cancer patients. Limits of physiological and pathological values, a quantity of which comes from the urethral glands and the umbilical median ligament (urachus), are still unknown. To establish the quantity of PSA secretion in the urethra, female PSAu was measured and found to be significantly low (< 0.1 ng/ml). The Authors report on 25 PR patients with negative margins and who had not received hormonal therapy for 30 months. The PSAu and the PSAs were measured on the 30th and the 60th day, and every 3 months thereafter in the first year and every 6 months in the second year. In 5 cases we observed an increase of PSAu between the 5th and 18th months. In 3 cases the PSAs increased 2 to 6 months later compared to the PSAu. In these 3 cases the biopsy indicated the presence of a localized relapse. Therefore the Authors recommend measuring the PSAu (cut-off 0.1 ng/ml) in the follow-up of the PR patients because the measurement may both identify a localized relapse earlier than the PSAs and indicate the localized response to hormonal or radiotherapy.
Adult↗
[Proposal of a new transurethral method for repeated prostatic biopsy].
In many clinical situations a patient affected by pre-cancerous prostatic lesions, suspected cancer or true cancer (assessed through biopsies or incidentally) must undergo iterative bioptic examinations. Three groups can be sub-divided: A) Patients with no previous endoscopic resection. B) Patients with previous endoscopic resection for BPH. C) Patients with previous RP for cancer. A persistent clinical suspicion for high PSA, a bioptic assessment for Ca T1c or PIN belong to the first group. A suspected cancer in a patient who had already undergone TUR, or a T1a neoplasia assessed incidentally, or PIN found in the resected fragments constitute the second group. A suspected local relapse after a RP characterizes the third group. In 28 cases of these clinical diagnoses, we have applied a new method of bioptic trans-urethral sampling. We used an eco-reflectant, flexible needle and applied it under endoscopic vision to the transitional zone or to tissues of the already resected prostatic fossa. In the first case these biopsies were integrative of the usual randomized biopsies. If transrectal ultrasound had given evidence of altered structures, biopsy was carried out with selective ultrasound guided technique. This procedure has proved to be minimally invasive, easy to carry out and particularly adapted to bioptise zones that are easier to reach transurethrally or tissues with low thickness.
Biopsy, Needle↗
Immunohistochemical localization of filaggrin in benign and malignant lesions of the human oral mucosa.
Filaggrin is a protein normally present in the granular and horny layer of stratified squamous epithelia. We studied the presence of this protein in 83 benign lesions and in 73 cases of malignant epithelial tumours of the oral cavity and investigated its possible role as an immunohistochemical marker. The immunohistochemical technique was based on the P.A.P. method. The results in benign lesions show a distribution of filaggrin similar to that observed in the normal mucosa. By contrast, an irregular distribution of filaggrin is observed in areas of leukoplakia with parakeratosis and in papillomas. In malignant lesions the expression of this protein is closely related to the degree of differentiation of the cellular elements, being positive in more differentiated and negative in anaplastic areas. Therefore in some types of benign lesions filaggrin testifies an alteration of the normal process of keratinization. Filaggrin is more significant in malignant lesions in which its presence if any permits an evaluation of the degree of differentiation of the tumour.
Carcinoma, Squamous Cell↗
Autogenous vein and nerve grafts: a comparative study of nerve regeneration in the rat.
A new experimental model using the rat sciatic nerve has been devised and used in ten rats to compare the results of using a vein and a nerve graft in different fascicles of the same sciatic nerve, a third fascicle being preserved intact as a control. The results, judged clinically, electrophysiologically and histologically, show persistence of the vein graft as a conduit even six months after the operation and a similar pattern of nerve regeneration in the two different grafts.
Animals↗
Metastatic atypical fibroxanthoma of skin.
Metastases from an atypical fibroxanthoma of skin have been reported but are very few in the literature. We had a personal case which, originally localized on the nostril, gave metastases to the cervical regional lymph node with no local recurrence. We examined both the primary and metastatic tumor by conventional histological stains and by immunoperoxidase technique to localize lysozyme, alpha-1-antitrypsin, ferritin and factor VIII antigens. The results show a clear correspondence between the primary and metastatic tumor.
Aged↗