bluuebunny/crossref_metadata_2025 huggingface dataset:
Vaginal misoprostol for cervical dilatation before operative office hysteroscopy
Authors: Atay V. , Duru N. K. , Pabuc¸cu R. , Ergu¨n A. , Tokac¸ G. , Aydin B. A.
Published: November 2003

Objective To assess the efficacy of misoprostol as an adjunct for easy cervical dilatation before operative office hysteroscopy under local anaesthesia.

Design Randomized, placebo‐controlled clinical trial.

Setting Tertiary centre for treatment of infertility.

Subjects Patients undergoing hysteroscopy, for simultaneous diagnostic and operative indications such as uterine septae, synechiae, submucous myomas, endometrial polyps and lost intrauterine devices, were included into the study

Intervention 43 cases were randomized to misoprostol (n=22) and placebo (n=21) groups. The drug was administered vaginally 4 h before hysteroscopy. Hysteroscopy was performed under local anaesthesia in an examination room as an office procedure.

Main outcome measures Rapid and easy dilatation, decreased pain, decreased incidence of cervical haemorrhage, laceration and uterine perforation.

Results In the misoprostol group, a 7‐mm hysteroscopic sheath passed easily without dilatation in 20 (91%) cases while it passed easily without dilatation in six (28%) of the placebo group (P<0.001). The average dilatation time for groups was 1.6 and 2.8 minutes respectively (P<0.05). Mean dilatation pain scores for the misoprostol and placebo groups were 5.1 and 9.3, respectively (P<0.05). Cervical bleeding was noted in two cases in the misoprostol group and laceration of the cervix was noted in three cases. In the placebo group there were eight cases each of both bleeding and laceration.

Conclusion Application of misoprostol does provide a safe, painless and effective means of cervical dilatation by chemical, rather than mechanical forces, and reduces complications such as cervical bleeding, laceration and uterine perforation.
Pelvic spreading of endometrial tissue during endometrial ablation
Authors: Depypere H. T. , Coppens M. , Van Kets H. , Serreyn R. , Versichelen L. , Dhont M.
Published: November 2003

Objectives To study the spread of endometrial cells through the fallopian tubes during endometrial ablation. Study Design In the Department of Gynecology at the State University Clinic of Ghent, 22 patients undergoing an abdominal hysterectomy were included in this prospective study. Immediately before the hysterectomy, endometrial resection of the posterior surface of the uterine cavity was performed. Both tubes and the peritoneal fluid were checked for the presence of endometrial tissue. Results Significantly (P < 0.05) more patients (5/7) with proliferative endometrium had endometrial tissue present in fluid from the pouch of Douglas and the tubal lumen compared with patients with secretory endometrium or those taking progestogens or oral contraception (1/13). Conclusion Endometrial tissue can be spread during endometrial ablation. Prior treatment with a contraceptive pill or progestogens reduces the incidence of spreading. These findings may be of relevance when a subclinical malignancy is present at the time of the procedure.
Mesenteric haematoma following laparoscopic surgery
Authors: Depypere H. T. , Coppens M. , Van Kets H. , Serreyn R. , Versichelen L. , Dhont M.
Published: November 2003

This report describes the development of a haematoma in the mesentery following laparoscopic ovarian cystectomy. A possible differential diagnosis and possible strategies to prevent this complication are discussed.
Incidence of recurrent ectopic pregnancy in relation to operative technique
Authors: Duru N. K. , Atay V. , Ergün A. , Pabuçcu R. , Dilek S. , Aydin B. A. , Tokaç G.
Published: November 2003

Objective To determine the incidence of recurrent ectopic pregnancies in four groups of patients with different conservative or radical operative techniques via laparoscopy or laparotomy. Design Retrospective analysis. Setting Tertiary centre for reproductive medicine Subjects 56 patients who were operated upon and followed up for at least 2 years were included in the study. Interventions The operations performed included linear salpingotomy (n = 21) and salpingectomy (n = 9) via laparoscopy, and linear salpingotomy with tubal reconstruction (n = 9) and salpingectomy with segmental resection (n = 23) at laparotomy. Results Recurrent ectopic pregnancy was found in 19% (4/21) of the laparoscopic salpingotomy group (P < 0.05). No recurrence was seen in the laparoscopic salpingectomy group. Recurrence was found in one case (11%) (p < 0.05) after salpingotomy with tubal reconstruction, and in one case (4.3%) of salpingectomy at laparotomy. Conclusion Conservative surgery for unruptured tubal pregnancy either via laparoscopy or laparotomy carries increased risk for repeated ectopic pregnancy.
Visceral leishmaniasis in haemophiliac patients with HIV: four case reports
Authors: LAFUENTE A. , LUACES M. R. , MAGALLÓN M. , MATEOS P. , CANO I. , CASTAÑEDA A. , LÓPEZ R. M. , PINILLA J. A. , MARTÍN M. P. , YUSTE V. J. , HDEZ‐NAVARRO F.
Published: November 2003

Visceral leishmaniasis (VL), an endemic parasitosis in Spain, is increasing as an important opportunistic infection in AIDS patients. We describe four cases of severe haemophilic patients with end‐stage HIV disease who present with visceral leishmaniasis. We report the clinical course, methods of diagnosis and response to therapy. From the assessed clinical data it does not appear to be any difference with regard to VL either in other HIV risk groups or in immunocompetent groups. In contrast with previous reports, we have found that despite their immunodepressed state, positive serology for Leishmania was found in three of the four cases. A similar observation has been made in patients with VL who are immunodepressed because of other reasons. We also confirm previous reports of poor response and intolerance of antimony treatment, the deteriorating course of the disease in AIDS patients and that there is only a slight relationship between the disease and the cause of patient death. We agree with the proposition that this pathology ought to be included in the definition critera for AIDS.
Osteonecrosis of the femoral head in haemophiliacs: not all joint disease is haemophilic arthropathy
Authors: Dye C. E. , Frauenhoffer E. E. , Vrahas M.
Published: November 2003

Osteonecrosis (ON) is rare while arthropathy is common in persons with haemophilia. A recent case of bilateral ON of the femoral head prompted us to review our experience with hip arthroplasty. We identified nine patients with presumed end‐stage haemophilic arthropathy. Four of the nine individuals had radiographic findings suggestive of ON, but without unequivocal microscopic evidence of ON. It is important to recognize ON at an early stage because there are surgical interventions which may prolong the life of the joint and improve quality of life. We suggest that ON should be included in the differential diagnosis of hip pathology in persons with haemophilia presenting with hip pain or dysfunction.
Liver failure and mortality in HIV‐positive haemophiliacs: FOURTEEN‐YEAR EXPERIENCE AND LITERATURE REVIEW
Authors: SCHWARTZ J. D. , ALEDORT L. M. , SEREMETIS S. V.
Published: November 2003

Progression to clinical liver failure has been observed in hepatitis C (HCV)‐infected, HIV‐seropositive haemophiliacs. We studied the records of 176 haemophiliacs who were infected with HIV and/or HCV seen between 1980 and 1993. Thirty‐two of 113 (28%) HIV‐seropositive patients died during the study period. Ten of these patients died of liver failure, representing 31% of all mortality. An additional four HIV‐seropositive patients who died of other causes had end‐stage liver disease. Clinical liver failure occurred in 12% of the HIV‐infected cohort. None of the HIV‐seronegative, HCV‐infected patients suffered from liver failure. Among HIV‐infected patients, liver failure was associated with advanced age and decreased CD4 counts. Severe, sporadic ALT elevations were associated with liver failure; persistent transaminase elevations were associated with mortality. We conclude that HIV infection enhances progression of HCV infection to clinical liver failure, and that liver failure is a major cause of mortality in HIV‐positive haemophiliacs.
Partial inhibition of platelet aggregation by nebulized pentamidine in severe haemophiliacs
Authors: CATTANEO M. , LECCHI A. , TRADATI F. , LOMBARDI R. , ZIGHETTI M. L. , GUARNERI D. , MANNUCCI P. M.
Published: November 2003

The antiparasite agent pentamidine has been shown to inhibit human platelet aggregation in vitro at concentrations that (potentially) may be attained in patient plasma after the administration of the drug by nebulizer. We measured platelet aggregation in platelet‐rich plasma (PRP) before and after the administration of 300 mg nebulized pentamidine to 10 HIV‐positive patients with severe haemophilia on prophylaxis against Pneumocystis carinii pneumonia. All patients had normal platelet counts. PAF‐acether, U46619, collagen and ADP at different concentrations were used as agonists. Platelet aggregation was lower in PRP samples taken at the end of pentamidine administration and 1 h thereafter than in samples taken at the same time points in control experiments (without the administration of pentamidine). The inhibition of platelet aggregation was mild and tended to be overcome by higher concentrations of platelet agonists. The bleeding time was prolonged from 5 to 15 min in one patient but did not change in the remaining nine patients. In conclusion, this controlled study shows that nebulized pentamidine inhibits platelet aggregation in HIV‐positive haemophiliacs without significantly affecting their bleeding times. Although this mild inhibitory effect may not be clinically relevant in haemophiliacs with normal platelet counts despite their defect in intrinsic coagulation, patients with HIV‐related thrombocytopenia should be monitored to detect any excessive prolongation of their bleeding times after nebulized pentamidine.
A clinical, histopathological and flow cytometric study of 149 complete moles, 146 partial moles and 107 non‐molar hydropic abortions
Authors: PARADINAS F.J. , BROWNE P. , FISHER R.A. , FOSKETT M. , BAGSHAWE K.D. , NEWLANDS E.
Published: November 2003

We have compared the clinical and histological features of 149 complete moles with 146 triploid partial moles and 107 diploid non‐molar hydropic abortions initially registered as moles for human chorionic gonadotrophin (hCG) follow‐up. Forty‐one patients with complete moles, five with partial moles and one with hydropic abortion received chemotherapy for hCG elevations interpreted as persistent trophoblastic disease. Complete moles were aborted or were evacuated significantly earlier than partial moles (means of 12.1 and 15.4 weeks; P <0.001) and hydropic abortions significantly earlier than complete moles (mean 10.7 weeks; P<0.005). The means of the highest recorded hCG were higher in complete moles (184 056 i.v.) than in partial moles (66 259 i.v.) and hydropic abortion (7942 i.v.). When hCG became normal without chemotherapy, this occurred earlier in patients with hydropic abortion than in those with partial moles (means of 46.7 days and 62.8 days; P<0.001) and earlier in partial moles than in complete moles (mean 78.3 days; P<0.005). The incidence of partial moles was comparable throughout fertile years but rose to 1.9 times the average after 40 years. Complete moles were commoner between 14 and 25 years and after 35 years, reaching 4.8 times the average after 40 years. Hydropic abortions were rare before 25 years and increased with age to 12 times the average after 40 years. Stromal karyorrhexis and shape of villi, before they become hydropic, discriminate well between complete and partial mole. Hydrops increased and vascularity decreased with molar age and the presence of non‐hydropic villi or vessels did not discriminate between partial mole and the younger complete moles evacuated nowadays.
Primary signet‐ring cell carcinoma of the urinary bladder
Authors: TORENBEEK R. , KOOT R.A.C. , BLOMJOUS C.E.M. , DE BRUIN P.C. , NEWLING D.W.W. , MEIJER C.J.L.M.
Published: November 2003

Signet‐ring cell carcinoma of the urinary bladder is a rare tumour, accounting for approximately 0.24% of all bladder malignancies. In this study, the clinicopathological findings in 13 cases are described. This malignancy is far more common in men than in women (ratio 11:2). The distribution by age and clinical symptoms can not distinguish it from transitional cell carcinoma. The tumour behaves like other high grade malignancies, presenting frequently at an advanced stage, and having an unfavourable clinical outcome. No special therapy seems superior to another.
Involvement of cell‐mediated killing in apoptosis in histiocytic necrotizing lymphadenitis (Kikuchi‐Fujimoto disease)
Authors: TAKAKUWA T , OHNUMA S , KOIKE J , HOSHIKAWA M , KOIZUMI H
Published: November 2003

Histiocytic necrotizing lymphadenitis, also called Kikuchi‐Fujimoto (KF) disease, is a benign disorder characterized histologically by paracortical necrotic foci surrounded by histiocytic aggregates. We analysed affected lymph node tissues from 34 patients with the disease in an attempt to elucidate its histogenesis. The ‘necrotizing’ cells showed typical apoptotic changes, including cell shrinkage and condensed and fragmented nuclei. Apoptotic bodies with a peculiar ultrastructure were demonstrated, and DNA fragmentation was detected in these cells by in situ end labelling. Immunostaining for the apoptosis‐regulating proteins bcl‐2, bax, c‐myc and p53 failed to show their involvement in KF disease. However, perforin, a killer cell‐specific cytolytic protein essential for provoking apoptosis in target cells, was found to be expressed abundantly by the infiltrating cells, which were thought to be cytotoxic T‐lymphocytes. Perforin‐expressing cells were present in the apoptotic foci of 28 of the 34 patients (82.4%). Virtually no cells containing perforin granules were present in non‐pathological regions, lymph node tissues from control subjects with reactive or tuberculous lymphadenitis or those from patients with KF disease with negligible apoptosis. Therefore, the ‘necrosis’ associated with KF disease appears to be attributable to trans apoptotic death of the killer cell target in the affected nodes. We propose that KF disease should be called apoptotic lymphadenitis.
Primary non‐Hodgkin's lymphoma of the thyroid gland: a population based study
Authors: PEDERSEN R.K. , PEDERSEN N.T.
Published: November 2003

During a 9‐year‐period, 50 cases of primary non‐Hodgkin's lymphoma (NHL) of the thyroid gland were reported to a population‐based lymphoma registry covering western Denmark giving an incidence of 2.06×10−6 cases per year. The male:female ratio was 1:4, and the mean age was 72.8 years for women and 62.8 years for men. On histomorphological reclassification 83% of the cases showed a high grade and 17% a low grade morphology. 98% had a B‐phenotype and 2% a T‐phenotype. In at least 33 of the cases, primary NHL of the thyroid gland was preceded by Hashimoto's thyroiditis and at least 25 of the patients had a high grade NHL which was transformed from Hashimoto's thyroiditis through a low grade B‐cell lymphoma of MALT type. The most frequent presenting symptoms were goitre (100%), hoarseness (57%), stridor/dyspnoea (55%) and dysphagia (45%); thirty‐six percent of the patients were hypothyroid at the time of diagnosis. Seventy‐six percent of the patients had localized disease (stages 1–2) and 24% had disseminated lymphoma (stages 3–4). Five year survival was 34.5% and 5 year cause‐specific survival 46.2%. The following factors were associated with a poor prognosis: stage 3–4 disease, elevated S‐urate, presence of hoarseness and age >66 years. Morphological subtype did not correlate significantly with survival.
Cystadenoma of spermatic cord resembling ovarian serous epithelial tumour of low malignant potential: immunohistochemical study suggesting Müllerian differentiation
Authors: MCCLUGGAGE W.G. , SHAH V. , NOTT C. , CLEMENTS B. , WILSON B. , HILL C.M.
Published: November 2003

A cystic lesion of the spermatic cord resembling an ovarian serous epithelial tumour of low malignant potential or borderline malignancy is reported. Immunohistochemical staining and electronmicroscropic examination suggested epithelial rather than mesothelial differentiation of the cyst lining cells. There was strong positive immunohistochemical staining of cyst lining cells for CA 125, providing evidence for Müllerian differentiation. A flow cytometric analysis of nuclear DNA content revealed a diploid profile.
Traumatic arterial damage after fine‐needle aspirational cytology in mammary complex sclerosing lesions
Authors: DAVIES J.D. , KULKA J.
Published: November 2003

We retrospectively reviewed 107 consecutive cases of radial scar and complex sclerosing lesions in a 54 month period seeking vascular lesions using archival H & E stained 5 μm thick sections. Eight showed vascular abnormalities, five being false aneurysms which were limited to 62 lesions >10 mm diameter; no false aneurysm was found in 45 radial scars ≤10 mm. All cases displayed arterial lesions, but two also showed associated venous fibrosis. Traumatic false aneurysms with loss or severe thinning of the media and intimal, medial or extravascular spindle cell proliferation were found in the arteries of five cases with histological evidence of local reaction to previous fine‐needle aspirational biopsy and clinical documentation of aspiration 18 to 121 days before. The diameters of the false aneurysms correlated with the original widths of the arteries. The other lesions with mature intimal fibrosis in arteries or veins lacked such local post‐aspiration expansile reactive changes, or a history of fine needle aspiration. We conclude that traumatic false aneurysms found in complex sclerosing lesions seem to be iatrogenic, resulting from fine needle aspiration. Mature fibrosis in veins or arteries are probably unrelated processes.
Immunolocalization of oestrogen and progesterone receptors in prostatic hyperplasia and carcinoma
Authors: HIRAMATSU M. , MAEHARA I. , ORIKASA S. , SASANO H.
Published: November 2003

Oestrogen receptors and progesterone receptors were immunolocalized in 19 patients with benign prostatic hyperplasia and in 26 patients with prostatic carcinoma. Immunohistochemistry was performed on tissue that had been fixed in 8% paraformaldehyde and then paraffin‐embedded, using microwave irradiation for antigen retrieval. Oestrogen receptor expression was observed exclusively in the stromal cells of six out of 26 (23%) patients with prostatic carcinoma, but in none of the cells of patients with benign prostatic hyperplasia. Progesterone receptor expression was detected in 16 of 19 (84%) and 17 of 19 (89%) of the epithelial cells and stromal cells of patients with benign prostatic hyperplasia, respectively. In patients with prostatic carcinoma, progesterone receptor immunoreactivity was observed in 12 of 20 (46%) and 20 of 26 (77%) of the carcinoma and stromal cells of prostatic carcinoma, respectively. The ratio of epithelial cells with progesterone receptor immunoreactivity corresponded well with that of stromal cells with immunoreactivity in patients with benign prostatic hyperplasia. However, the ratio of stromal cells with progesterone receptor immunoreactivity was much higher than that in carcinoma cells in patients with prostatic carcinoma. Immunolocalization patterns or the ratio of the cells with progesterone receptor immunoreactivity did not significantly correlate with histological differentiation or patient’s age in carcinoma cases. However, patients with advanced surgical stages of disease demonstrated a significantly smaller number of carcinoma and stromal cells with progesterone immunoreactivity in patients with prostatic carcinoma. These results suggest that oestrogens do not have a direct effect on the biological behaviour of benign prostatic hyperplasia and prostatic carcinoma, but that progesterone appears to play a role in the pathogenesis of benign prostatic hyperplasia and prostatic carcinoma.
Comparison of cytomorphological and architectural heterogeneity in mammographically‐detected ductal carcinoma in situ
Authors: HARRISON M. , COYNE J.D. , GOREY T. , DERVAN P.A.
Published: November 2003

Many classification schemes have been proposed for ductal carcinoma in situ. Architectural heterogeneity is widely recognized. Cytonuclear grade appears to have greater prognostic significance than architectural pattern. This study assesses heterogeneity using a classification based on cytological grade and compares this to architectural heterogeneity in mammographically detected ductal carcinoma in situ. One hundred and twelve cases were classified according to architectural subtypes and the carcinoma nuclei were graded. Necrosis and micro‐ calcification were assessed. Eighty‐four percent of ductal carcinomas in situ had a single nuclear grade, whereas only 39% showed a single architectural pattern. High grade nuclei were present in 87% of cases. Necrosis was associated with high nuclear grade. In contrast to architectural heterogeneity, this study shows little ductal carcinoma in situ heterogeneity when classification is based on nuclear grade. Thus, a cytomorphological classification should have the advantage of consistency and reproducibility in comparison to architecture‐based classification systems.
Diagnostic accuracy of stereotactic core biopsy in a mammographic breast cancer screening programme
Authors: DAHLSTROM J.E. , JAIN S. , SUTTON T. , SUTTON S.
Published: November 2003

Stereotactic core biopsy was performed on 200 women for 206 mammographically suspicious non‐palpable lesions detected over a period of 2 years as part of the Australian national programme for early detection of breast cancer. This study aimed to assess the reliability of stereotactic core biopsy in this context and to develop a protocol for the evaluation of stereotactic core biopsy in mammographically detected non‐palpable breast lesions. Fifty‐one of 52 malignant lesions found by stereotactic core biopsy were confirmed by excision biopsy (one woman declined excision). Nine (4.5%) women had atypical ductal hyperplasia on stereotactic core biopsy; at excision, six were low grade carcinomas (in situ or invasive carcinomas), one was a 3 mm focus of grade 3 invasive duct carcinoma, one was atypical ductal hyperplasia, and one patient refused excision biopsy. In 29 (14.5%) women the histology of the stereotactic core biopsy was considered not to correlate with the radiological abnormality, and excision biopsy was advised: in four of these women carcinomas were found. One hundred and ten (55%) women had 116 benign lesions on stereotactic core biopsy: on follow‐up, one of these patients has been found to have a carcinoma. Core biopsy number and sequence were analysed demonstrating that no particular biopsy was more diagnostic than any other, and that the diagnostic yield of three cores was statistically equal to that of five cores. The procedure was well‐tolerated and there were few complications. Thus, stereotactic core biopsy is an accurate and safe method for diagnosis of mammographically detected non‐palpable breast lesions, and we believe it is the diagnostic technique of choice in breast cancer screening programmes. However, a stereotactic core biopsy diagnosis of atypical ductal hyperplasia requires excision biopsy since a diagnosis of low grade intraduct carcinoma cannot be excluded. Furthermore, if tissue obtained by stereotactic core biopsy does not correlate with the mammographic abnormality, excision biopsy should be performed.
Genetic pathways in colorectal cancer
Authors: ILYAS M. , TOMLINSON I.P.M.
Published: November 2003

The model of colorectal tumorigenesis put forward by Fearon and Vogelstein has had great influence on molecular oncology. They proposed that a series of mutations occur in the progression from normal cells to colorectal cancer and that these mutations are associated with the histological features of such tumours. Several postulates of the model appear to be correct, particularly its emphasis on the stepwise accumulation of genetic changes and the inclusion of mutations at the adenomatous polyposis coli (APC) and TP53 loci. Since the publication of the original model, however, mutations at other loci have been identified which may be alternatives or additions. There is also evidence to suggest that some colorectal cancers develop along a different genetic pathway. In this review, we discuss how tumour development can occur as Darwinian evolution through selection of advantageous somatic mutations. The non‐random nature of mutation selection gives rise to genetic pathways of tumorigenesis. In addition, we consider the Fearon and Vogelstein model, its shortcomings and possible additions to it. The evidence suggests that not all colorectal cancers follow the same genetic pathway during carcinogenesis.
EGF‐receptors in human normal and pathological thyroid tissue
Authors: WESTERMARK K. , LUNDQVIST M. , WALLIN G. , DAHLMAN T. , HACKER G.W. , HELDIN N‐E. , GRIMELIUS L.
Published: November 2003

Expression of the epidermal growth factor receptor (EGFR) was studied in cryosections from human thyroid tissues. Normal tissue (4 cases), nodular goitre (12), toxic goitre (9), adenoma (9), follicular carcinoma (1), papillary carcinoma (7) and poorly differentiated carcinoma (1) were used for immunohistochemistry. Northern blot analysis was performed in two nodular goitres, three adenomas, two papillary carcinomas, one follicular carcinoma and the adjacent normal tissue in five cases as well as in two cell lines from anaplastic carcinomas. Epidermal growth factor receptor immunoreactivity was detected in all tissues examined. The amount of EGFR mRNA did not differ between normal and abnormal tissues. However, the EGFR staining was weaker in normal thyroid tissue compared to the adjacent neoplastic areas suggesting an upregulation at the posttranslational level in the latter. A strong staining was also seen in hyperfunctioning thyroid glands. The EGFR location was mainly basal or basolateral in all thyroid tissues with normal histology and in toxic diffuse goitre. Pericellular and sometimes cytoplasmatic staining was seen in neoplastic tissues. In nodular goitre the staining was both basal, lateral and apical and varied in intensity. Our data suggest that a non‐polarized location of EGFR probably indicates a loss of the normal epithelial cell polarity and could be interpreted as an early sign of dedifferentiation. Furthermore, a role for the EGFR is proposed, not only in the development of thyroid neoplasias but also in goitre formation.
Cardiac myxoma is rich in factor XIIIa positive dendrophages: immunohistochemical study of four cases
Authors: BERRUTTI L. , SILVERMAN J.S.
Published: November 2003

Cardiac myxoma is an enigmatic tumour thought to arise from primitive cardiac mesenchymal cells. Factor XIIIa+ dendrophages are tissue histiocytes that are active in tissue repair and thrombosis. To explore whether factor XIIIa+ dendrophages play a role in cardiac myxoma morphogenesis, we stained four cases with an antiserum against coagulation factor XIIIa (FXIIIa). We also used antibodies recognizing CD34, CD31, and S‐100 protein. Samples of valvular endocardium from 12 and 16 week fetuses and two adult autopsies were compared with the four myxomas. All cardiac myxomas had rounded and dendritic FXIIIa+ cells admixed with more numerous CD34+ spindle and stellate myxoma cells. The CD34+ cells formed multicellular syncytia and capillary sprouts. Many of these syncytial structures also expressed CD31 and, to a lesser extent, S‐100 protein, strongly in two cases and more focally in two. Fetal subendocardium was composed of CD34+ stellate fibroblast‐like cells invested with scattered FXIIIa+ histiocytes; no S‐100+ cells were detected. Our findings confirm that cardiac myxomas are composed of CD34+ primitive subendocardial cells. These cells show a capacity for CD31+ endothelial differentiation. In cardiac myxoma, the CD34+ myxoma cells are accompanied by numerous FXIIIa+ dendrophages, the presence of which suggests abnormal organizing thrombus‐like differentiation in cardiac myxoma morphogenesis.
Apoptosis occurs independently of bcl‐2 and p53 over‐expression in non‐small cell lung carcinoma
Authors: O'NEILL A.J. , STAUNTON M.J. , GAFFNEY E.F.
Published: November 2003

Certain oncogenes and tumour suppressor genes are known to modulate apoptosis. To investigate whether over‐expressed bcl‐2 and abnormally stabilized p53 are associated with reduced apoptosis in paraffin sections of non‐small cell lung carcinoma, apoptotic, mitotic, and Ki‐67 labelling indices were determined and correlated with bcl‐2 and p53 immunoreactivity in 54 squamous cell carcinomas and 22 adenocarcinomas. Nineteen squamous cell carcinomas (35.2%) showed over‐expression of bcl‐2, but all 22 adenocarcinomas were bcl‐2 negative. Thirty‐seven squamous cell carcinomas (68.5%) and 13 adenocarcinomas (59.1%) showed p53 over‐expression. Apoptotic tumour cells were identified among p53 positive and bcl‐2 positive tumour cells. There was a significant linear correlation between apoptotic indices and mitotic indices. bcl‐2 over‐expression and p53 over‐expression were not associated with attenuated apoptosis, or altered mitotic or Ki‐67 labelling indices in either tumour type. Neither bcl‐2 nor p53 was of prognostic significance. These results suggest that apoptosis in non‐small cell lung carcinoma occurs independently, and is not modulated primarily by, bcl‐2 or p53. It is likely that the effects on apoptosis of bcl‐2 and p53 are countered by those of other oncogene products and/or additional factors that regulate apoptosis in vivo
Occurrence of multiple lymphoepithelioma‐like carcinomas and MALT‐type lymphoma in the stomach: detection of EBV in carcinomas but not in lymphoma
Authors: GREINER A. , KIRCHNER T. , OTT G. , MARX A. , FISCHBACH W. , MÜLLER‐HERMELINK H.K.
Published: November 2003

A multifocal lymphoepithelioma‐like carcinoma and a low‐grade B‐cell lymphoma of mucosa‐associated lymphoid tissue (MALT‐type) were found simultaneously in the stomach of a 65‐year‐old patient. Carcinoma and lymphoma were intimately associated forming complexes resembling lymphoepithelial lesions at the primary gastric site and in lymph node metastases. The two tumours had developed on a background of severe chronic‐atrophic gastritis of the mucosa of antrum and fundus. Autoantibodies to normal gastric glandular tissue could be demonstrated in the patient’s sera. Using non‐radioactive in situ hybridization (ISH), Epstein‐Barr virus (EBV) sequences were detected in virtually all carcinoma cells but neither in the non‐neoplastic mucosa nor in the lymphoma. These findings suggest that a focal EBV infection occurred early in the development of the carcinoma followed by a subsequent clonal expansion of the EBV‐containing tumour cells. A neoplastic transformation in MALT‐type lymphoma is not EBV‐related but might be triggered by altered immune mechanisms.
Nodular intra‐abdominal panniculitis: an accompaniment of colorectal carcinoma and diverticular disease
Authors: BAK M.
Published: November 2003

Intra‐abdominal panniculitis is a tumour‐like inflammatory condition of adipose tissue. The aetiology and pathogenesis of the disease is unknown, but a number of associated diseases have been recorded. It has been customary to deal with only primary cases in the literature. This study was undertaken in order to describe the entire spectrum of the disease including primary as well as secondary cases. Eleven patients are reported, nine of which had an associated colorectal disease in direct continuity with areas of intra‐abdominal panniculitis. It is concluded that intra‐abdominal panniculitis should not be regarded as a specific nosological entity but merely a result of injury to the fat cells. Intra‐abdominal panniculitis is seen more often as a secondary local phenomenon than as a primary condition, and in both cases it is associated with considerable differential diagnostic problems. Primary diseases involved are, among others, colorectal carcinoma and diverticulosis. The aetiologic agent(s) are still unknown, but substances liberated from a damaged bowel might play a pathogenetic role.
Human pulmonary dirofilariasis
Authors: PAMPIGLIONE S. , RIVASI F. , PAOLINO S.
Published: November 2003

Two new cases of human pulmonary dirofilariasis, in a 66‐year‐old woman and a 69‐year‐old man, respectively, both living in the Po valley, are described. They represent the 7th and 8th cases reported in Italy and seem to be ascribable to Dirofilaria repens, even though the poor state of preservation of the parasites did not allow the morphology of the species involved to be clearly defined. In both cases, the false clinical diagnosis of lung cancer was based on the accidental radiological discovery of a coin lesion, the nematodes being located in a pulmonary artery producing a small, roundish infarct.
Parotid involvement by desmoplastic melanoma
Authors: JENNINGS T.A. , OKBY N.T. , SCHROER K.R. , WOLF B.C. , MIHM M.C.
Published: November 2003

Desmoplastic malignant melanoma often arises in sun damaged skin of the head and neck and shows frequent neurotropism. Although metastatic melanoma frequently involves the parotid, direct spread to the parotid has been rarely reported. We evaluated five cases of desmoplastic malignant melanoma involving the parotid gland with clinical and pathological evidence of precursor cutaneous lesions in four of the five cases. The parotid involvement in four cases was tumoural, and three of these were not clinically suspected to be melanoma. The histological appearance in all five cases was that of a sarcomatoid tumour. Immunohistochemistry and electronmicroscopy performed on three of the cases showed only evidence of schwannian differentiation: the tumour cells were positive for S‐100 protein and vimentin, and negative for cytokeratin and HMB‐45. Electronmicroscopy showed no evidence of melanogenesis. All five tumours showed histological evidence of prominent neurotropism with one case demonstrating extension from overlying skin along cutaneous nerves to the superficial parotid. Thus, desmoplastic malignant melanoma may involve the parotid by neurotropic spread and can be pathologically indistinguishable from malignant schwannoma, a diagnosis which may be made erroneously in the absence of clinical information.
Expression of β‐catenin in normal breast tissue and breast carcinoma: a comparative study with epithelial cadherin and α‐catenin
Authors: HASHIZUME R. , Koizumi H. , IHARA A. , OHTA T. , UCHIKOSHI T.
Published: November 2003

Expression of β‐catenin was investigated in normal breast tissue and 66 breast carcinomas in conjunction with expression of epithelial cadherin (E‐CD) and α‐catenin. In normal mammary ducts and acini, intense β‐catenin immunoreactivity was present at the basolateral surfaces of luminal epithelium and weak immunoreactivity was observed at the lateral borders of myoepithelial cells. No β‐catenin was revealed at the myoepithelial basal surface. The intercellular expression of β‐catenin, as well as of E‐CD and α‐catenin, was also observed in carcinoma tissues with varying staining intensity. Almost all of 10 intraductal carcinomas and approximately 70% of 41 invasive ductal carcinomas expressed the three molecules at the same level as in normal glands, whereas approximately 80% of 13 invasive lobular carcinomas showed severe deficiency of them. Two lobular carcinomas in situ showed complete absence of all of the proteins. Some of these findings were confirmed biochemically by immunoblotting analysis. In invasive ductal carcinomas, α‐catenin was reduced more frequently in diffuse than in solid type tumours, whereas the level of expression of β‐catenin and E‐CD was unchanged between them. No correlation was present between reduced expression of the adhesion molecules and lymph node metastasis.
Thrombomodulin as a marker of vascular and lymphatic tumours
Authors: APPLETON M.A.C. , ATTANOOS R.L. , JASANI B.
Published: November 2003

The aim of this study was to evaluate the utility of a new commercially available antibody to thrombomodulin as an endothelial marker in formalin‐fixed paraffin‐embedded tissue. The expression of thrombomodulin in a variety of 50 vascular and lymphatic neoplasms and malformations was compared to the expression of von Willebrand factor, QBend 10 (CD34) and JC70 (CD31). We showed that thrombomodulin was the best marker of lymphatic endothelium and also stained a higher percentage of malignant vasoformative tumours when compared to the other markers. We recommend the assessment of thrombomodulin expression in the differential diagnosis of malignant vasoformative neoplasms and in the detection of lymphatic endothelium for evidence of tumour permeation.
Gastrointestinal autonomic nerve tumours: a report of nine cases
Authors: SHANKS J.H. , HARRIS M. , BANERJEE S.S. , EYDEN B.P.
Published: November 2003

We describe the clinicopathological features of gastrointestinal autonomic nerve tumours in nine patients where the diagnosis was confirmed by electronmicroscopy. Most patients presented with abdominal pain. At laparotomy, large intra‐abdominal tumour masses were found which tended to be cystic and haemorrhagic. The predominant histological patterns were nests, sheets and fascicles of spindle and epithelioid cells. Immunohistochemistry showed positive staining for neuron specific enolase (9/9), PGP 9.5 (9/9), NKI/C3 (7/9), vimentin (7/9), α‐smooth muscle actin (5/9), vasoactive intestinal peptide (3/9) and CD34/QBend10 (2/9). Grimelius staining was positive in two of nine cases. All tumours were negative for CAM 5.2, chromogranin, synaptophysin, Leu 7, neurofilament protein, muscle‐specific actin (HHF‐35) and desmin (D33). Ultrastructural examination showed cellular processes and dense‐core granules in all cases. Three tumours had microtubules and/or intermediate filaments, particularly in cell processes. Skeinoid fibres were seen in three cases. No convincing synapses or small (synaptic‐type) vesicles were identified. There was no evidence of epithelial, smooth muscle or nerve sheath differentiation. Two patients died due to tumour, two died of unknown causes and the remainder are alive 2–44 months after presentation. Four of the five survivors have recurrent/residual intra‐abdominal tumour. So‐called gastrointestinal autonomic nerve tumours are apparently slow‐growing malignant tumours showing neuronal differentiation. Four cases arose in the mesentery/retroperitoneum or omentum rather than bowel wall and therefore a more appropriate nomenclature might be intra‐abdominal stromal tumour with neuronal differentiation.
Small cell carcinoma of the liver: a hitherto unreported variant of hepatocellular carcinoma
Authors: ZANCONATI F. , FALCONIERI G. , LAMOVEC J. , ZIDAR A.
Published: November 2003

We report three cases of an unusual primary carcinoma of the liver composed of small cells. The patients were adult males (56 to 89 years) who presented with jaundice, weight loss and abdominal discomfort. Surgery was attempted in one case. Clinical evolution was rapid, with death ensuing between 1 and 5 months after diagnosis. Surgical (1 case) and autopsy (2) tissues were available for review. All three tumours arose in non‐cirrhotic livers. They were composed of broad nests of small epithelial cells with little supporting tissue. They were positive for low‐molecular weight keratins and alpha‐fetoprotein. One case was immunoreactive for erythropoietin antigen. Expression of neuroendocrine markers was focal and erratic. No immunostaining was observed for carcinoembryonic antigen or S‐100 protein. In one case ultrastructural investigation disclosed canaliculi surrounded by microvilli and junctional complexes. In the light of these features, it appears that small cell carcinoma represents a rare, but definite variant of hepatocellular carcinoma. Although it does not segregate in a peculiar clinical setting, it should be distinguished from metastatic pulmonary small cell carcinoma as well as from other malignancies featuring small cells.
Differentiation towards gastric foveolar, mucopeptic and intestinal goblet cells in gallbladder adenocarcinomas
Authors: KUSHIMA R. , LOHE B. , BORCHARD F.
Published: November 2003

Cellular differentiation in 22 surgically removed adenocarcinomas of the gallbladder was immunohistochemically studied with antibodies specific to mucins of gastric foveolar cells (M1), (pseudo)pyloric cells (M2) and intestinal goblet cells (M3), and also with antibodies against pepsinogen II and chromogranin A. More than 70% of tumours (16 of 22 cases) displayed gastric‐and/or intestinal‐type differentiation, most of which (12 of 16 cases) showed both types of differentiation. Two tumours showed an organoid growth pattern similar to the normal gastric mucosa. The presence of endocrine cells positive for chromogranin A was closely related to that of gastric‐ and/or intestinal‐type cells. The present findings clearly indicate the multidirectional differentiation of gallbladder adenocarcinomas and suggest that most gallbladder adenocarcinomas develop and progress under induction of gastric and intestinal differentiation.
Intestinal metaplasia subtyping: evaluation of Gomori's aldehyde fuchsin for routine diagnostic use
Authors: SHAH K.A. , DEACON A.J. , DUNSCOMBE P. , PRICE A.B.
Published: November 2003

Aims:

Intestinal metaplasia (IM) has been implicated in the pathogenesis of gastro‐oesophageal carcinoma, but because of its common occurrence, its specificity for use in cancer surveillance is low. IM subtypes characterized by mucin phenotype have been studied to try and improve specificity.

Methods and results:

On balance, type III IM seems the most promising for use in gastric cancer surveillance. The situation is problematic at the gastro‐oesophageal junction where the normal occurrence of acidic mucins raises doubt on the value of subtyping. High iron diamine–Alcian blue combination (HID‐AB) is commonly used for IM subtyping, but its potential toxicity and long staining period (up to 24 hours) precludes widespread clinical use. This study has compared the sulphomucin staining ability of Gomori's aldehyde fuchsin–Alcian blue combination (GAF‐AB) against HID‐AB for identifying and subtyping IM in gastric and oesophageal biopsies.

Conclusions:

Compared to HID‐AB, a sensitivity of 85%, a specificity of 100% and a staining time of less than 30 minutes, shows this stain to be a simple and effective technique for identifying and subtyping IM in routine laboratories.
Expression of stratified epithelial‐type cytokeratins in hyalinizing trabecular adenomas supports their relationship with papillary carcinomas of the thyroid
Authors: FONSECA E. , NESLAND J.M. , SOBRINHO‐SIMÕES M.
Published: November 2003

Aim:

To evaluate the cytokeratin pattern of expression of hyalinizing trabecular adenomas and to verify whether or not these tumours, that share morphological features with papillary carcinomas, present the stratified epithelial‐type cytokeratins commonly found in ordinary papillary carcinomas.

Methods and results:

This study consisted of the immunohistochemical detection of simple and stratified epithelial type cytokeratin filaments in a series of six hyalinizing trabecular adenomas, three papillary carcinomas with a trabecular growth pattern and two carcinomas combining hyalinizing trabecular and papillary patterns. Simple epithelial‐type cytokeratins 7, 8, 18 and 19 were found in every case. Expression of the stratified epithelial‐type cytokeratins 1, 5/6 and/or 13 was detected in four hyalinizing trabecular adenomas.

Conclusion:

Based on this, as well as on the cytological features and on the frequent co‐occurrence of hyalinizing trabecular adenoma and papillary carcinoma, we suggest that the former lesion may be considered a peculiar encapsulated variant of papillary carcinoma.
Pancreatic tissue in a lateral cervical cyst attached to the thyroid gland—a presumed foregut remnant
Authors: LANGLOIS N.E.I. , KRUKOWSKI Z.H. , MILLER I.D.
Published: November 2003

Aim:

To report the previously undescribed occurrence of a lateral neck cyst, attached to the thyroid gland, containing pancreatic tissue.

Methods and results:

A 41‐year‐old man presented with a recurrent cystic lesion of the thyroid. At thyroidectomy cystic masses containing mucinous material were present in the neck, and there was a nodular lesion attached to the lower pole of the thyroid. Histological examination of the latter lesion revealed an epithelial lined cyst, with pancreatic tissue (exocrine and endocrine) in addition to fat, fibrous tissue, muscle and cartilage in the wall.

Conclusions:

The possible origin of this structure is discussed, with the conclusion being that it most likely represents a foregut remnant.
Rhabdomyomatosis of the newborn lung unassociated with other malformations
Authors: HARDISSON D. , GARCÍA‐JIMÉNEZ J.A. , JIMÉNEZ‐HEFFERNAN J.A. , NISTAL M.
Published: November 2003

Aims:

To describe a case of rhabdomyomatosis of the lung unassociated with other external or visceral malformations in a newborn infant.

Methods and results:

A 26 weeks' gestation newborn male with no relevant medical or family history presented a well‐circumscribed solid area in the posterior mediastinum occupying the upper lobe of the right lung. The possibility of neuroblastoma or an extralobar pulmonary sequestration were excluded after laboratory and arteriographic studies. No visceral anomalies were found. At the age of 9 months the patient underwent a partial lobectomy, and he is free of disease 39 months after surgery. Histological examination demonstrated the presence of numerous bundles of striated fibres arranged haphazardly in the pulmonary interstitium in a background of a type‐II congenital cystic adenomatoid malformation‐like morphology of the resected lung.

Conclusion:

The presence of striated muscle fibres in the lung not necessarily represents a lethal congenital malformation. As this case shows, rhabdomyomatosis of the lung can affect a single pulmonary lobe, and resection of the affected lung parenchyma may be curative. It is important for pathologists to be aware of this entity, although it is exceptional, and to include it in the differential diagnosis of pulmonary masses in the newborn lung.
Down‐regulation of CD95 (Fas/Apo‐1) in the epithelia of adenovirus‐infected appendices
Authors: LAROUSSERIE F. , BERREBI D. , FLORENTIN A. , DE LAGAUSIE P. , AIGRAIN Y. , PEUCHMAUR M.
Published: November 2003

Aims:

Adenoviral inclusions are commonly seen in appendices from infants with intussusception. They are associated with focal epithelial budding and less frequently with epithelial shedding. These morphological changes could depend on the opposing effects of adenoviral gene products on CD95‐mediated apoptosis.

Methods and results:

Appendices from intussusceptions with viral inclusions (n = 4) and normal appendices (n = 10) were studied by immunochemistry with anti‐adenovirus, anti‐CD95 and anti‐HLA‐DR antibodies. Apoptosis was studied by the TUNEL method. The mucosa of normal appendices contained no adenoviral protein. CD95 was present in all epithelial cells except Paneth cells. HLA‐DR was absent in epithelial cells and apoptosis was seen only in germinal centres and in a few surface epithelial cells. The epithelium of appendices from intussusceptions contained nuclear inclusions labelled with anti‐adenovirus antibody, always found in the epithelial buds. The epithelial CD95 pattern was drastically altered in adenovirus‐infected appendices. CD95 was absent from the budding foci. In these foci, HLA‐DR was overexpressed. There was also increased epithelial apoptosis in areas remote from those lacking CD95 antigen.

Conclusions:

The appearance of epithelial budding or shedding in appendices from intussusception could be due to focal in situ differences in the expression of adenoviral genes.