Sabato 27 ottobre 2012 - Pacini Editore

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344 liferative disorders in the axillary nodes of patients with newly diagnosed breast cancer: a case series. Clin Breast Cancer 2011;11:61-6. 6 Lee HB, Park JC, Lee YS, etal. Unexpected synchronous follicular lymphoma of paraaortic and pelvic lymph nodes in a patient with endometrial carcinoma: a case report. Eur J Gynaecol Oncol 2011;32:334-5. 7 Pastolero G, Coire C, Asa SL, Concurrent Medullary and Papillary Carcinomas of Thyroid with Lymph Node Metastases: A Collision Phenomenon. American Journal of Surgical Pathology 1996;20:245- 50. 8 Zane KW, Shippey JE, Gregory A, et al. Collision Metastasis of Prostatic and Colonic Adenocarcinoma: Report of 2 Cases. Archives of Pathology & Laboratory Medicine 2004;128:318-20. 9 Maher AS, Lama Z, Raffat A.S. Collision Metastasis of Breast and Ovarian Adenocarcinoma in Axillary Lymph Nodes: A Case Report and Review of the Literature. Pathology & oncology research 2009;15:423-7. Toothpick pneumonia, a rare case in adult L. Gnetti1 , F. Brigati1 , R. Manuguerra1 , A. Casalini2 , M. Anghinolfi2 , M. Majori2 , E.M. Silini1 1 Azienda Ospedaliero-Universitaria di Parma, Dipartimento Onco-Ematologico Internistico, Sezione di Anatomia Patologica; 2 Azienda Ospedaliero-Universitaria di Parma, dipartimento Cardio-Nefro-Polmonare, Sezione di Pneumologia ed Endoscopia Toracic. Introduction. We present a case of a 39-years-old black man with increasing dyspnea and acute respiratory failure initially treated for PNX with a pleural drainage. Case presentation. Routine chest radiographs revealed a layer of PNX in right lung and air space consolidation no better be characterized. We found in his history a computed tomography scan investigation, with and without contrast medium, made some months before for the same problems. The result was a suspected foreign body inhalation because CT scan showed the presence of area of thickening lung (maybe of inflammatory source), embedding a foreign tubular body with calcific density (bone?) inside the bronchus of the right lung. We subject the patient to flexible bronchoscopy to remove but the foreign body was so embedded in the granulation tissue that this reaction didn’t allowed the removal of the foreign body. Bronchial aspiration and biopsy demonstrated only an inflammatory granulomatous outcome. Due to clinical and radiological issue a simple pulmonary lobectomy was made. During the sampling we observed inside a bronchial branch a foreign wooden body of 28 mm surrounded by parenchimal lung with increased consistency. Results. The man developed a cronic pneumonia in organization, secondary an endobronchial foreign body. At the end, this strange, not characterizable foreign body was a toothpick that the patient inhalated ten years before. Discussion. Foreign pneumonia in adult is rare. The foreign body in our patient is also present ten year before to CT, but the patient didn’t performed a flexible bronchoscopy. The granulation tissue embedded the foreign body preventing the good performance of flexible bronchoscopy so the patient went to surgery. In this case Fig. 1. CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012 the sampling begin important to demonstrate the presence of foreign body and subsequently the cause of pneumonia. references 1 Lai YF, Wong SL, Chao TY, et al. Bronchial foreign bodies in adults. J Formos Med Assoc 1996;95:213-7. 2 Boyd M, Chatterjee A, Chiles C, et al. Tracheobronchial foreign body aspiration in adults. South Med J 2009;102:171-4. 3 Yonker LM, Fracchia MS. Flexible bronchoscopy, Adv Otorhinolaryngol 2012;73:12-8. 4 Takenaka M, Hanagiri T, Ono K, et al. Management of patients with bronchial foreign bodies. J UOEH 2011;33:157-61. Type II congenital pulmonary airway malformation and intralobar pulmonary sequestration: a rare association due to a possible defect of endodermal/mesoderm development M.G. Mastrogiulio, A. Barone, M.R. Ambrosio, A. Ginori, A. Carbone, D. Spina Section of Pathological Anatomy, Department of Human Pathology and Oncology, University of Siena, Policlinico Santa Maria alle Scott, eSiena, Italy Background. Bronco-pulmonary malformations include a wide variety of abnormalities of the respiratory tract. Lesions are usually isolated; however, the association of two or more of them has been not rarely described. Their classification has been always somewhat problematic as well as their terminology. Congenital pulmonary airways malformations and pulmonary sequestrations have been included by Gerle (1968) into broncopulmonary foregut malformation. Today, there is a substantial agreement in the classification of congenital pulmonary airways malformations (CPAM). Type I CPAM is characterized by large, multiloculated cysts of more than 2 cm in maximum diameter; type II, presents cysts of less than 2 cm in maxim diameter; in type III, no macroscopically evident cysts can be detected. Pulmonary sequestration with systemic vascular connection is a well defined entity. The term defines a developmental malformation composed of isolated nonfunctioning lung segments with no communication with functional tracheobronchial elements of the surrounding lung. Its abnormal systemic arterial supply derives from either single or multiple vessels from the distal thoracic or proximal abdominal aorta or other arteries. Intralobar lung sequestration must be kept separate from extralobar sequestration (ELS), since it consists of aberrantly located pulmonary bud that develops apart from the normal lung. While type II CPAM is frequently associated with ELS, the concurrence of CPAM and ILS, although described in rare cases, is much more controversial. Herein we illustrated such an association, focusing on its pathogenic mechanism and classification. Materials and methods. A 30-year-old woman was evaluated by routine prenatal ultrasound scan (US) at 25 weeks of gestation. US showed the presence of multiple large cysts in the right lung of the fetus. Anamnesis was negative. A female was born by a full-term delivery. At birth, she presented an acute respiratory distress syndrome. Heart US showed a moderate left- right shunt due to septal interatrial defect. There was also an increased venous pulmonary return for a pulmonary sequestration. At chest multirow detector computed tomography (MDCT), a multicystic mass in the lower lobe of the right lung, was observed. The largest cyst was of 23 mm of diameter and presented air-fluid level. The mass showed a systemic blood supply from a large arterious vessel originating from the abdominal aorta. An enlarged right lower pulmonary vein drainage it. A small ectopic bronchus for the superior lobe was detected on the right side of the trachea. A right lower lobectomy through a postero-lateral thoracotomy was performed at the age of 4 month. Post surgery course was free of complications. Results The surgical specimen consisted of right lower lobe measured 7x5x6 cm. In the congested, red-wine basal posterior
COmuNiCaziONi ORali segment, at the transition between thoracic and diaphragmatic surface, a systemic artery (5 mm in maximum diameter) was identified. It branches into the basal pyramid. There was no well defined separation between the territory supplied by these branches and the remaining lung parenchyma. The cut surface of the lung parenchyma showed multiple dilated spaces ranging in size from few millimeters to 2 centimeters, 15 of them being more than 1 cm in greatest dimension. The intervening normal parenchyma was tan-pink colored. The cysts were sometimes encircled by a thin wall with the inner surface lined by a translucent mucosa without any papillary projections or exudates. The apical segment was normal. On microscopic examination, the walls of the cysts was 150 micron thick. They were formed by a central area rich in blood vessels and lymphatics, separated from the epithelial inner layer by bundles of smooth muscle (30 micron thick). Most of the cysts were lined by a monostratified ciliated epithelium. In some areas, small, sparse islands of cartilage were observed. The walls of the cysts were generally smooth, however, a few of them had a small number of papillary projections. Mucinous cells and striate muscle cells were absent. Pleural blood vessels were congested and lymphatic vessels were dilated. Abnormal arterial vessel branches were thick and contained uninterrupted, circular elastic fibers, as do the normal elastic arteries. They irregularly branched into the basal posterior segment, sometimes forming conglomerates of contiguous, large vessels not orderly connected with the adjacent cystic parenchyma. The parenchyma adjacent to the systemic artery branches showed congestion and areas of hemorrhagic infarction. Basal segments of the arterial vessels were hypoplasic. The epithelial cells lining the cysts showed the immunophenotye of bronchiolar epithelial cells: basal positivity for p63 and CK5 and apical positivity for TTF1 and CK7. They were also positive for D2-40, as were the endothelial cells of the lymphatics. No lesions were showed in the apical segment. Conclusions. In the case herein described two lesions were present in the inferior lobe of the right lung, the type II congenital airway malformation (CPAM type II) and the intralobar sequestration (ILS), diagnosed on a fetus at 25 weeks of gestation. Both lesions were in the basal segments of the right inferior lobe. CPAM is frequently associated with bronchial atresia and ELS. On the contrary, it is very rarely associated with ILS. Is this latter, although very rare, association accidental or due to a pathogenetic connection? It is known that, during the development, lung buds are enveloped in a continuous mesenchymal background. At an early stage, vessels form the foregut-mesodermal pulmonary plexus, which is connected with the branchial arteries and, after the 13 th week, with the pulmonary arteries. Later on, these connections regress. All these stages regulated by molecular interactions between mesoderm and endoderm. It may be that these interactions are abnormal leading to a endodermal development block and, morphologically, to a pseudoglandular pattern. Abnormalities of the mesodermal component may prevent the connection of the pulmonary plexus with the pulmonary arteries and may determine the persistence of the connection with the systemic arteries. In fact, in the case herein illustrated, pulmonary vessels are hypoplasic in the basal segments. Moreover, the expression in our case of the oncofetal antigen M2A (a sialoprotein of the cell surface) in the epithelial cells lining the cysts, like the expression described in the basal cells of bronchi and bronchiole, confirms a possible defect of mesoderm development. Whether this hypothesis was true, CPAM might not be an amartomatous lesion since it would be not site-dependent but time-dependent. The criterion of the time-related endodermal/mesodermal abnormality, might be used, in agreement with Clement et al (8), for the classification of the “broncopulmonary foregut malformation”. references Lee ML, Tsao LY, Chaou WT, et al. Yang, Kun-Tu Yeh, Jou-Kou Wang, Mei-Hwan Wu, Hung-Chi Lue, Ing-Sh Chiu and Chung-I Chang. Revisit on congenital bronchopulmonary vascular malformation: a 345 haphazard branching theory of malinosculations and its clinical classification and implication. Pediatric Pulmonology 2002;33:1-11. Jin ZW, Nakamura T, Yu HC, et al. Fetal anatomy of peripheral lymphatic vessels: a D2-40 immunohistochemical study using an 18-week human fetus (CRL 155 mm). J Anat 2010;216:671-82. Kambouchner M, Bernaudin J-F. Intralobular Pulmonary Limphatic Distribution in Normal Human Lung Using D2-40 Antipodoplanin Immunostaining. Journal of Histochemistry & cytochemistry 2009;57:643-8. Langston C. New concepts in the pathology of congenital lung malformations. Seminars in Pediatric Surgery 2003;12:17-37. Corbett HJ, Humphrey GME. Pulmunary sequestration. Paediatric Respiratory Review 2004;5:59-68. Couluris M, Schnapf BM, Gilbert-Barness E. Intralobar Pulmonary Sequestration Associated With A Congenital Pulmonary Airway Malformation Type II. Fetal and Pediatric Pathology 2007;26:207-12. Pulmonary adenocarcinoma metastatic to the appendix: an additional case V. Mourmouras1 , M.R. Ambrosio2 , B.J. Rocca2 , S. Giunti1 , A. Amorosi1 1 2 Centro Oncologico Fiorentino, Sesto Fiorentino; Departement of Human Pathology and Oncology, Anatomic Pathology Section, University of Siena, Italy Background. Malignant tumors of the appendix are rare and metastatic neoplasms of the appendix are very uncommon manifestations. Of all the cases that have been reported so far, metastatic malignancies have been carcinomas of the breast, lung, pancreas, kidney and ovary. We herein describe another case of lung adenocarcinoma metastatic to the vermiform appendix. Material and methods. A 57 year-old white male was admitted in the hospital with a 4-day history of right lower quadrant pain. The abdomen was tender over McBurney’s point with rebound tenderness, and the psoas sign, as well as Rovsing’s sign and the obturator sign were positive. The white blood cell count was elevated (13.500/µL). Immediate laparotomy, carried out for a suspect clinical diagnosis of acute appendicitis, showed localized peritonitis. The appendix was perforated and it was obstructed by a firm nodule at the distal portion. The postoperative course was uneventful. His medical history indicated that 2 years earlier he had undergone upper right lung lobectomy due to a lung adenocarcinoma. Results. The surgical specimen consisted of a 12 cm-long ileocecal specimen, with an appendix measuring 7 cm, covered by a yellowish brown exudate. Serial sectioning through the distal portion of the appendix showed a whitish, firm nodule measuring 4.5 cm, which caused marked narrowing of the lumen in this region. At the same area a perforation of the wall was found. Histopathologic examination showed intact mucosa with an underlying adenocarcinoma, appearing as solid and papillary nests, infiltrating all the layers of the appendiceal wall, reaching the visceral serosa, without penetrating it. Surgical margins were negative and regional lymph nodes were free of tumor. Immunohistochemical evaluation showed positivity of the neoplastic cells for CK7, TTF-1, Napsin-A, and negativity for CK20, as well as CDX2. On morphological and immunophenotypical basis the diagnosis of a metastatic lung adenocarcinoma was made. Conclusion. Tumors of the appendix are very rare, with the majority being primary appendiceal malignancies such as carcinoid and adenocarcinoma. Metastatic disease to the vermiform appendix is an infrequently seen subset of these lesions, with the most common primaries being breast, lung, pancreas and kidney. An extensive search of the literature showed reports of lung carcinoma metastatic to the vermiform appendix to be extremely rare, being described only one previous case of pulmonary adenocarcinoma metastatic to the appendix. We report an additional case of appendiceal metastasis of lung carcinoma, which clinically simulated an acute appendicitis. Although this clinical scenario is uncommon, it is important for surgeons to bare in mind that
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206 rare tumors with various biolog
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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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250 techniques have resulted in the
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252 Predictive factors in colorecta
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256 Quanto ai mediatori, in caso di
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258 L’incidenza media complessiva
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patHOlOGiCa 2012;104:267-358 COMUnI
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COmuNiCaziONi ORali Solitary T-cell
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COmuNiCaziONi ORali Tab. I. CYTOLOG
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COmuNiCaziONi ORali The aim of the
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COmuNiCaziONi ORali Tab. I. R-MSFTs
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COmuNiCaziONi ORali Fig. 1. skin us
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COmuNiCaziONi ORali complications.
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COmuNiCaziONi ORali Immunohistochem
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COmuNiCaziONi ORali advanced pathol
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COmuNiCaziONi ORali Fig. 4. tCRGd+c
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COmuNiCaziONi ORali LOH analysis of
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Page 171 and 172: PoStER references 1 Gerber DE, Minn
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PoStER Results. At gross examinatio
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Pathologica 2012;104:421-423 InDICE
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