Sabato 27 ottobre 2012 - Pacini Editore

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298 - improvement in the quality of FNA on echographic guidance; - improvement in the quality of diagnosis; - reduced discomfort for Patients. The aim of the training course was: to provide extensive knowledge of: - echographic diagnostics - cytologic diagnostics - FNA procedures for cytologic diagnostics to provide technical abilities in the management of FNA on echographic guidance. The lecturers were radiologists with regard to echographic diagnostics, and pathologists as far as cytologic diagnostics and FNA procedures were concerned. The course will be repeated in 2013 with another two editions. The preliminary data that we collected from 2007 to 2011 allow us to conclude that a properly trained pathologist is perfectly capable of performing FNA on ecographic guidance without help from a radiologist. Hepatocellular carcinoma with fatty change insurgent on hepatocellular adenona in noncirrhotic liver: report of a case E. Projetto, V. Terrinazzi, F. Castiglione, C. Comin, L. Messerini Università di Firenze Dipartimento di Area Critica Medico-Chirurgica, Sezione di Anatomia Patologica Hepatocellular carcinoma (HCC) is one of the more common malignancy in the world. HCC is strongly associated with Hepatitis B infection and liver cirrhosis. We report a case of a 33-year-old woman who developed an hepatocellular carcinoma without liver cirrhosis but in association with a marked liver steatosis. The patient underwent hepatic resection of the fifth and sixth segment. Macroscopically the resected liver parenchyma appeared almost entirely replaced by yellowish multinodular lesions together with diffuse hemorrhagic-necrotic areas. Histologically, the nodules were composed of atypical hepatocytes; the architectural pattern was trabecular and acinar.The reticulinstain showed that the reticular trama was interrupted in several areas, suggesting the diagnosis of HCC. The histopathological diagnosis of HCC was also supported by immunohistochemistry (CD34, HSA, CD10, pCEA). Interestingly, most of the neoplastic cells showed a marked steatosis. The histologic pattern was consistent with the final diagnosis of hepatocellular carcinoma with fatty change. Diagnostic use of tissue microarray technology: how, when D. Pilla, F. Bosisio, G. Cattoretti AO San Gerardo e Universitá di Milano-Bicocca, 20900 Monza (MB) Fifteen years and threethousand more publications after the first (Kononen J, et al. Nat Med 1998;4:844-7), Tissue Microarray technology (TMA) is used largely if not only for research, to produce high throughput data from formalin fixed, paraffin embedded (FFPE) samples. The publications dealing with the diagnostic use of the TMA may be counted on one hand. This may be due to several factors: few centers have a daily volume of cases amenable to TMA use (breast, colon, lung) high enough to justify the setup and the turnaround time (TAT) required for diagnosis. In addition, pathologist, whose daily routine implies sampling, are wary of underrepresentation of the lesion due to limited sampling because of heterogeneity in the tissue. Lastly, and in addition to what has been stated before, because the TMA technology is perceived as a research tool, able to provide prognostic rather than diagnostic results, thus not useful for the day-to-day routine. The throughput that can be afforded with the TMA allows the gathering of data whose analysis is not affected by tissue heterogeneity or individual sampling errors (Nocito A, et al. J Pathol CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012 2001;194:34-57; Camp RL, et al. J Clin Oncol 2008;26:5630-7). Key to diagnosis in Pathology is the control of errors in identifying patients and samples. This issue has not been raised so far when using the TMA technology. This is surprising, because the same rule applies to research and industrial procedures. We addressed and solved this issue, opening the use of the TMA technology to its use for diagnosis. We introduced the use of a Code128 1D barcode on slide labels, TMA blocks and TMA slides. The barcode on routine slides contains the unique slide ID. We fetched from the LIS via a barcode reader and a small query created by our LIS vendor five fields: slide ID (the leading item to track the case), accession number, specimen and block, patient’s unique ID and date of accession. The slides selected and marked by the pathologists are scanned and a resulting small database file is inserted directly into the donor block window of the Galileo (ISEnet srl) TMA arrayer program. Next, the acceptor block ID, barcoded in advance on the recipient virgin block, is scanned into the program. The array construction must fulfill the following standards: - intrinsically asymmetric design, with a design which can guarantee asymmetry even upon loss of a single spot or a row. - no sectors, randomly placed patient’s samples if replicated samples are required. - barcode ID-recognition driven verification of each donor block before coring. All these features are available with several TMA instruments, including the Galileo CK4500 (ISEnet srl). The TMA design and the associated data are exported from Galileo as an xml file, which is fed to an Aperio Spectrum database (Aperio, USA). Sections cut from the TMA and stained in single, double or multiple immunohistochemistry or immunofluorescence are labeled with the TMA ID, barcoded, and scanned on an Aperio Scanscope CS or FL scanner, enabled for barcode recognition. The match between individual whole slide images (WSI) and the corresponding TMA design is made via an automated recognition of the ID on the design and the slide, provided with an ad-hoc software patch developed by Nikon Italia and Aperio. Once the correct design and the associated data are linked to the TMA WSI, the process of segmentation is started by superimposing a design grid on the correctly oriented WSI. To fulfill the identification of each sample, the grid must be a lattice of circles connected by fixed linear segments, to be adjusted to the WSI of the slide. The software then generates individual images for each patient, with an analytical error estimated around 1 every 85.000 reads (Snyder ML, et al. Clin Chem 2010;56:1554-60). This error rate is lower than the pre-analytical error of the system. Patient’s images are reached from the LIS by the use of any of the unique ID built in the system, and a diagnosis can be rendered. The diagnostic use of TMA technology opens up new fields for pathologists, both because of the cost-saving and tissuesparing ability of the technology and because of the intrinsic high throughput power. One field is screening each and every colon, ovary and endometrial cancer for mutation mismatch repair (MMR) protein loss, in order to identify patients with a genetic rather than somatic cause for the loss (Funkhouser WK, et al. J Mol Diagn 2012;14:91- 103). Together with the analysis for BRAF mutations, this approach is able to identify > 90% of the cancer prone families in the area served by the Pathology Department. A second field is the identification of rare (< 5%) patients with a cancer phenotype amenable to personalized therapy. Five % of colon cancers express Her2 (Nathanson, DR. et al. Int J Cancer 105, 796–802, 2003) or have ALK genomic amplification (Lipson D, et al. Nat Med 2012;18:382-4), yet it is economically unpractical to stain each and every colon cancer for these phenotypes. A third emerging field is tracking tumor heterogeneity; staining whole sections from multiple blocks of large tumors (e.g.
COmuNiCaziONi ORali kidney) is unpractical. However, several cases may be sampled and stained if multiple cores are allocated in a diagnostic TMA. We wish to thank Roberto Marotta (Noemalife), Stefano Faggi, Emanuele Martella (Nikon Italia and Aperio), Paolo Forlani, Maurizio Falavigna, Pasquale DeBlasio (ISEnet), Simone Borghesi (UNIMIB) for great collaboration with this project. Maria Cristina Argentieri e Angelita Ferri contributed to the project. The Tissue Microarrayer and the Aperio Scanscope FL were provided through a grant from the Regione Lombardia (Call for Independent Research, DDG 6716 del 1/7/2009). Blastomycosis-like pyoderma: a case report of a rare entity G. Crisman1 , A. D’Amuri2 , F. Floccari 2 , E. Villani2 , C. Miracco3 , A.S. Senatore2 , P. Leocata1 1 Anatomia Patologica, Dipartimento di Scienze della Salute, Università dell’Aquila, L’Aquila, Italia; 2 U.O.C. Anatomia Patologica – P.O. Gallipoli – ASL Lecce, Lecce; 3 Anatomia Patologica, Dip. di Patologia Umana ed Oncologia, Università di Siena Background. First described in 1898 by Hallopeau under the term of “pyodermite végétante”, and subsequently redefined as “pseudo-epitheliomatous cutane” by Azua and Pons, Blastomycosis-like pyoderma (BLP), or pyoderma vegetans, is a rare vegetating inflammatory tissue reaction due to a bacterial infection (commonly due to Pseudomonas aurigenosa, Proteus mirabilis, E. coli, Candida albicans, Staphylococcus aureus, β-hemolytic streptococci) generally occurring in patients with reduced immunological resistance status. Matherial and methods. We report on a case of a 63-year-old man presented with one-year history of a dorsal, ulcerated, vegetating, reddish nodule with multiple pustules, of 3cm in-diameter. Anamnestic data revealed a prostatectomy for an adenocarcinoma one year before. Results. The lesion has been surgically excised and the histological features revealed a marked pseudoepitheliomatous hyperplasia with a mixed inflammatory infiltrate composed by lymphocytes, plasmacells, neutrophils and eosinophils spreading in the superficial and deep dermis. Multiple abscesses and foci of necrosis were observed as well. Microbiological stains (Periodic acid-Schiff, Gram, Grocott) gave negative results. Immunohistochemical stains revealed a positivity of the inflammatory cells for CD68, CD20 and CD3. The patient showed a moderate response to antibiotics and anti-inflammatory agents. The differential diagnosis should include cutaneous metastasis, giant keratoacanthoma, squamous cell carcinoma, deep fungal infection (especially, North American blastomycosis) and mycobacterial infection. Conclusions. Since BLP is a rare condition, an accurate anam- Fig. 1. clinical presentation of the lesion. Fig. 2. Histological features: pseudoepitheliomatous hyperplasia with a mixed inflammatory infiltrate (H&E, 4x magnification). 299 Fig. 3. mixed inflammatory infiltrate and congestion f the superficial plexes of capillaries and vennles of the skin. (H&E, 20x magnification). nestic analysis can provide critical information to achieve a correct diagnosis. There is no standard treatment and in some cases, antibiotics were ineffective despite bacteria were isolated. Some authors reported usefulness of a acitretin therapy. references 1 Bianchi L, Carrozzo AM, Orlandi A, et al. Pyoderma vegetans and ulcerative colitis. Br J Dermatol 2001;144:1224-7. 2 Su WP, Duncan SC, Perry HO. Blastomycosis like pyoderma. Arch Dermatol 1979;115:170-3. 3 Trygg KJ, Madison KC. Blastomycosis like pyoderma caused by Pseudomonas aeruginosa: Report of a case responsive to ciprofloxacin. J Am Acad Dermatol 1990;23:750-2. 4 Singh M, Kumar B, Kaur S, et al. Blastomycosis like pyoderma. Indian J Dermatol Venereol Leprol 1985;51:226-8. 5 Brown CS, Kligman AM. Mycosis like pyoderma. Arch Dermatol 1957;75:123-5. 6 Nguyen RT, Beardmore GL. Blastomycosis-like pyoderma: Successful treatment with low-dose acitretin. Australas J Dermatol 2005;46:97-100.
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Periodico bimestrale - POSTE ITALIA
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VENTANA iScan HT Riconcepire le imm
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08.30 - 10.30 10.30 - 11.30 Sala DO
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202 gli attuali approcci multidimen
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204 of Florence, University of Pisa
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206 rare tumors with various biolog
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208 died of disease. Incomplete res
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212 Key words: EGC, Prognosis, Trea
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214 Tab. VI. univariate analysis: 5
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216 the surgeons perform a pancreat
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218 Tab. I. RB-ILD DIP LCH olitis (
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220 ciation of Medical Oncology (AI
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222 and CD56 are the best immunosta
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224 by the general pathologist [1.8
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226 na illuminazione, da un vulvolo
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228 9 Lynch PJ, Moyal-Barocco M, Bo
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230 Procedure di analisi del linfon
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232 are classified as G1 NETs, foll
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234 31 Nugent SL, Cunningham SC, Al
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236 mas and leukemias, whereas the
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238 Patobiologia della parete aorti
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240 10 Luo BH, Carman CV, Springer
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242 zienti asintomatici, la sede pi
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244 Anatomia patologica e citopatol
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246 Fig. 1 logico o cell-blocks, co
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COmuNiCaziONi ORali TESTA COLLO Lym
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COmuNiCaziONi ORali references 1 Sa
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COmuNiCaziONi ORali of the paranasa
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COmuNiCaziONi ORali general dental
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COmuNiCaziONi ORali P16 immunohisto
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Pathologica 2012;104:359-420 POSTEr
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PoStER references 1 Gerber DE, Minn
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PoStER In our case the endofibrotic
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PoStER Fig. 1. Kaplan-meier surviva
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PoStER believed the use of atypical
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PoStER references 1 Goepel JR. Beni
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PoStER MALT lymphoma of the rectum:
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PoStER 3 Ciulla A, Castronovo G, To
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PoStER for protein expression of PA
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PoStER the better one because the m
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PoStER Grossly, an irregular villou
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PoStER Expression of ror-1 in pancr
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PoStER (see Fig. 1) placental site
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PoStER Tissue were fixed in 10% for
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PoStER invaded focally adjacent tun
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PoStER bination chemotherapy the pr
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PoStER 21 to 55 years in age, the l
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PoStER Results and conclusion. We a
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PoStER Identification of cancer ste
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PoStER Epidemiological and biomolec
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PoStER Fig. 1. ductal invasive Brea
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PoStER Fig. 2. Fig. 3. Fig. 4. Conc
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PoStER monly develops in elderly ad
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PoStER haematoxylin and eosin and V
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PoStER Fig. 4. High mitotic rate (a
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PoStER Fig. 6. focal sebaceous and
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PoStER Results. At gross examinatio
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PoStER strated that HPV is present
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PoStER Fig. 1. EE primary intestina
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PoStER Introduction. Angiosarcoma i
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PoStER 9 Klein KA, Stephens DH, Wel
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Pathologica 2012;104:421-423 InDICE
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Sabato 27 ottobre 2012 - Pacini Editore

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